Accounting for ART status and CD4 count closest to the time of TB diagnosis, food insecurity continued to be associated with increased symptoms of depression (adjusted PR = 2·33; 95 % CI 1·24, 4·38) and anxiety (adjusted PR = 1·53; 95 % CI 1·03, 2·26) in the multivariable model. Here, CD4 is linked to depressive disorder.