Objectives The aims of this study were to collect and review tuberculosis (TB)-HIV data for Europe and to provide an overview of current health policies addressing co-infection. Methods We collected reported cases of TB-HIV from the 25 most affected member states of the World Health Organization (WHO) European region. Countries were also asked whether they had implemented health policies covering collaborative TB-HIV activities and what their main achievements, obstacles and needs were in addressing TB-HIV. Results Twenty countries reported registering a total of 6925 TB-HIV cases in 2005. Among TB patients tested, 3.3% were found to be HIV-positive, up from 2.1% in 2004. The male-to-female ratio was 2.7:1. The largest percentage of co-infections were reported in people aged 25-34 years (47.8%). Recommended TB-HIV policies have been implemented in many of the countries. Conclusions Case-finding has improved in many countries and the reported incidence of TB-HIV is increasing in the European region, particularly among young adults, although it remains low compared to other parts of the world. Strengthened coordination of existing TB and HIV services is still needed.