Objective. To assess the radiographic features in patients with Human Immunodeficiency Virus (HIV) complicated by pulmonary tuberculosis (PTB), and the association with CD4 lymphocyte count and sputum smear. Method. A prospective study was carried out on 89 HIV positive patients with PTB. The demographics, smoking history, sputum smear result, chest radiographic findings and CD4 lymphocyte count were documented. Results. Out of the 89 patients recruited in the study, 41 were males and 48 were females. Eighteen (18) patients had typical radiographic features, 60 patients had atypical radiographic features while only 11 of them had normal radiographic films. Sixty eight (68) patients had CD4 count <200？cells/mm3, 19 patients had CD4 count between 200–499？cells/mm3, while only 2 patients had CD4 count from 500？cells/mm3 upwards. The association between low CD4 count and radiographic finding was statistically significant, ( value ). Sixty (60) patients had negative sputum smear for Acid and Alcohol Fast Bacilli (AAFB), while the remaining 29 patients had positive smear. The association between low CD4 count and negative smear was statistically significant ( value ). Conclusion. The radiographic pattern and the result of the sputum smear for AAFB has a significant relationship and association with the immune status of patients with Human Immunodeficiency Virus (HIV) complicated by pulmonary tuberculosis. 1. Introduction Human immunodeficiency virus (HIV) is a potent risk factor for tuberculosis (TB), both through an increase in the reactivation of the latent Mycobacterium tuberculosis infection and through an accelerated progression from infection to active disease, by undermining the cell-mediated immunity through depletion of CD4 lymphocytes [1–4]. TB has a great impact on morbidity and mortality in HIV-1 infected individuals than all other opportunistic infections [3]. TB and HIV infections have a synergistic influence on the host immunoregulation. TB can develop at any stage of immunosuppression regardless of the level of the circulating CD4+ T-lymphocytes [4]. CD4+ lymphocytes count is one of the surrogate markers for evaluating the degree of immunosuppression and HIV disease progression [4]. The levels of circulating CD4+ lymphocytes has a great impact on the radiographic pattern of TB. In HIV infections, TB can produce both typical and atypical radiographic patterns depending on the degree of immunosuppression [5–8]. Atypical radiographic presentations are lower frequency of cavitations, higher frequency of mediastinal lymphadenopathy, lower lung zone
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