Orel oblast, Russia, is the site of a WHO demonstration project for tuberculosis control. We used data acquired by the Center for Prevention of AIDS and Infectious Diseases to show that, in this region, the seroprevalence of HIV-1 infection has increased 33-fold in 4 years. The rapid spread of HIV-1 in Russia has serious implications for control of tuberculosis epidemics. Although the HIV-1 epidemic is at an early stage, aggressive prevention measures must be taken quickly to avoid the adverse effects of widespread HIV on tuberculosis control that have been seen in sub-Saharan Africa.