<p>Tuberculosis affects almost every organ of body, including neck, with tuberculous cervical lymphadenitis being the most common form of extra-pulmonary tuberculosis. High burden of tuberculosis among HIV-infected individuals emphasizes importance of timely diagnosis, treatment, and prevention in this group. To assess clinicodemographic profile of patients with cervical tuberculous lymphadenitis, prevalence of HIV co-infection, and frequency of paradoxical reactions after initiation of anti-tubercular therapy. This prospective observational study was conducted in otorhinolaryngology department at tertiary care hospital in Navi Mumbai over a period of three years. A total of 117 patients presenting with clinical features suggestive of tuberculous lymphadenitis and subsequently confirmed histologically were included. All patients were assessed for clinical, radiological, and pathological parameters. Most commonly affected age group was 18–30 years, with female preponderance. Out of 117 patients studied, 82 (70.1%) belonged to rural areas. Paradoxical reactions following initiation of anti-tubercular therapy (ATT) were observed in 9 patients (7.7%). ATT completion rate was 82.1% (96 patients), while 20 patients (17.1%) were non-compliant. HIV seropositivity was detected in 5 patients (4.3%). Lower middle socioeconomic class was predominant in study population and was associated with higher rates of non-compliance with treatment. No significant differences were observed between seropositive and seronegative participants with respect to cytopathological features, microbiological findings, or response to treatment. Frequency of paradoxical reactions was higher among HIV-seropositive individuals.</p>