Back ground: rnHuman immunodeficiency virus, multi-drug resistant tuberculosis and extensive drugrnresistant tuberculosis are emerging as major challenges facing tuberculosis control programsrnworldwide (especially in Asia and Africa). The challenge is not only from a public healthrnpoint of view but also in the context of global economy, especially in the absence ofrntreatment for multi-drug resistant tuberculosis at national-level programs in developingrncountries. The association between multi-drug resistant tuberculosis and HumanrnImmunodeficiency Virus infection has not yet been fully investigated and the results of thernstudies so far conducted were not consistent. rnObjective: The aim of this study was to summarize the evidence on the association betweenrnmulti-drug resistant tuberculosis and HIV infection through a systematic review of existing rnliterature. rnMethods: Literature based systemic review of observational studies was conducted.rnOriginal studies providing Mycobacterium tuberculosis resistance data stratified by Human rnImmunodeficiency Virus status were identified using data bases such asrnMEDLINE/PUBMED, Google Scholar and HINARI. The descriptions of original studiesrnwere made using frequency and forest plot. Publication bias was assessed using Funnel plotrngraphically and Egger weighted and Begg rank regression tests statistically. Heterogeneityrnacross studies was checked using Cochrane Q test statistic and Irn2rn. Pool risk estimates ofrnmulti-drug resistance tuberculosis and sub-grouping analysis were computed to analyzernassociations with Human Immunodeficiency Virus status. rnResults: Random effects meta-analysis of all the 24 observational studies showed thatrnHuman Immunodeficiency Virus infection was associated with an increased risk of multi-rndrug resistant tuberculosis (summery odds ratio 1.24; 95%, 1.04 â€“ 1.43). Subgroup analysesrnshowed that effect estimates were higher for primary multi-drug resistance tuberculosis andrnin population based studies. rnConclusions: Human Immunodeficiency Virus infection is positively and significantlyrnassociated with an increased risk of multi-drug resistant tuberculosis regardless of study base rnand multi-drug resistant tuberculosis type. There should be strong collaboration betweenrnHuman Immunodeficiency Virus and tuberculosis control programs.