Introduction: Tuberculosis is a major public health problem in the world, especially in the developing countries like India. Also MDR-TB and HIV: TB co-infection are major hurdles to achieve the aim and objectives of our national tuberculosis programme. Objectives: 1. To diagnose Mycobacterium tuberculosis (MTB) infection in clinically suspected cases of pulmonary tuberculosis using Gene Xpert. 2. To find out HIV: TB co-infection rate. 3. To find out prevalence of Rifampicin sensitive and resistant cases in diagnosed tuberculosis patients. 4. To study factors responsible for Rifampicin resistance (MDR-TB) Material and Methods: This retrospective study included 278 sputum samples from Jan 2015-Dec 2015 from registered RNTCP patients. The samples were subjected to Xpert MTB/RIF Assay for use with the Cepheid Gene Xpert. The Ziehl - Neelsen smear finding was provided by the RNTCP __ampersandsignndash;DOTS regional centres. Results: A total number of 278 sputum samples were subjected to Gene Xpert analysis in the year 2015. MTB could be detected in 137 (49.28%) cases. In the rest 141 cases where MTB was not detected 14 samples reported error on Gene Xpert. Out of 278 cases, 209 (75.18%) were HIV negative, and 69 (24.82%) were HIV positive. In 69 clinically suspected HIV: TB co-infection cases, MTB could be detected in 22 (31.88%) cases. Out of these 22 cases, 4 (18.18%) were smear positive. Out of 137 MTB detected samples, 117 (85.4%) were rifampicin sensitive, 2 (1.46%) were rifampicin indeterminate resistant and 18 (13.14%) were rifampicin resistant. According to RNTCP programme criteria for suspected MDR __ampersandsignndash;TB, out of 18 MDR-TB cases, 12 (66.67%) cases were - smear positive at diagnosis , retreatment case; 3 (16.67%) cases were - any follow up smear positive, 2 (11.11%) - had contact of known MDR -TB case and 1(5.56%) - was HIV: TB case. Conclusion: Gene Xpert was a useful tool in detection of HIV-TB co-infection. In our study out of 69 clinically suspects HIV: TB co-infection cases, one third cases were confirmed by Gene Xpert. Thus, 44 patients were not put on unnecessary AKT and were kept on follow-up. Even though the association of MDR-TB and HIV co-infection was not very significant in this study, it would not be too long before witnessing a rapid increase of MDR-TB among HIV patients if adequate and immediate measures are not taken. In the present study, MDR-TB detection rate was high among re-treatment cases. Emphasis has to be given for completion of primary treatment on time and taking proper nutrition. Patients usually stop treatment once they feel better within 2 month of starting the treatment. Special counselling and education is needed at this juncture. In our study, two cases of primary MDR-TB were from household contact. Hence, health workers must generate awareness and educate patients and family members about the risk of acquiring Primary MDR-TB to prevent its spread.