People living with human immune deficiency virus (HIV) infection who smoke tobacco are more likely to develop several opportunistic infections, and also suffer complications from antiretroviral medication than the non smokers of tobacco. The burden of tobacco smoking amongst people living with this infection is poorly understood in the African population. The aim of this study was to establish the prevalence and determinants of tobacco smoking among HIV patients in North Eastern Nigeria. We enrolled 312 adult HIV sero-positive patients attending the Federal Medical Centre Yola, Nigeria. A modified World Health Organisation (WHO) recommended questionnaire was used to obtain information from consented subjects. The prevalence of current cigarette smoking among HIV patients was 22.1%. The male to female ratio of smokers was 2:1. Peer pressure (25.8%) and pleasure (25.8%) were reported as the most common reasons for smoking tobacco. Multivariate analysis shows that male gender, age ranged 40-49 years, alcohol drinking and CD4 T lymphocyte count <200 cells/mm3 were positively associated with tobacco smoking. The prevalence of tobacco smoking among HIV patients in North Eastern Nigeria was high. Therefore, smoking should be discouraged in people living with HIV to reduce their morbidity and mortality.