To determine whether increased dietary iron could be a risk factor for acti
ve tuberculosis, dietary iron history and human immunodeficiency virus (HIV
) status were studied in 98 patients with pulmonary tuberculosis and in 98
control subjects from rural Zimbabwe. Exposure to high levels of dietary ir
on in the form of traditional beer is associated with increased iron stores
in rural Africans. HIV seropositivity was associated with a 17.3-fold incr
ease in the estimated odds of developing active tuberculosis (95% confidenc
e interval [95% CI], 7.4-40.6; P<.001), and increased dietary iron was asso
ciated with a 3.5-fold increase (95% CI, 1.4-8.9; P =.009). Among patients
treated for tuberculosis, HIV seropositivity was associated with a 3.8-fold
increase in the estimated hazard ratio of death (95% CI, 1.0-13.8; P =.046
), and increased dietary iron was associated with a 1.3-fold increase (95%
CI, 0.4-6.4; P =.2). These findings are consistent with the hypothesis that
elevated dietary iron may increase the risk of active pulmonary tuberculos
is.