The article estimates the number of tuberculosis (TB) cases and related deaths among people living with HIV (PWH) in PEPFAR-supported countries in 2021. A total of 386,862 PWH had tuberculosis, of which PEPFAR detected and treated 144,146 cases, thereby missing 242,716 cases (63%). An estimated 106,967 PWH died of TB caused by tuberculosis that year. PEPFAR reports only incomplete data on deaths, for example only 1645 TB-related deaths among nearly 18 million PWH. The standard WHO screening method for four symptoms was used in 87% of PWH, with only 2.7% having positive tests, which is lower than in the literature (30–67%). The number of missed diagnoses decreased from the previous year, but has increased overall since 2018, while mortality estimates have been decreasing since 2018. Median national antiretroviral therapy (ART) coverage in the analyzed countries was 80% (range 20–60%).[1]