Screening for HIV in patients with tuberculosis (TB) is essential, as HIV/TB co-infection has an adverse prognosis. We compared HIV testing practices in 2005 and 2008/09 in the Birmingham and Solihull region of the UK and evaluated the trends before and after the implementation of the British HIV Association (BHIVA) HIV testing guidelines (2008). A total of 371 TB patients in 2005 and 407 in 2008/09 were included. Demographics across both cohorts were similar. HIV testing increased from 14% in 2005 to 43% in 2008/09. Patients aged ≥55 years and Asian patients were less likely to be tested in 2005 and those aged ≥35 years in 2008/09. An increased rate of HIV testing was seen in all patient categories in 2008/09 compared with 2005. The odds of being tested was high in black African patients (compared with white ethnicity) in both years and increased among black Africans and African Caribbeans between both time points, albeit with wide confidence intervals (CIs). No significant difference in HIV testing was found in 2008/09 before and after the publication of the BHIVA guidelines. This study underlines the importance of continued efforts to minimize the significant gaps in HIV testing rates in TB services.