Objective: We describe chest radiograph (CXR) findings in a population with a high prevalence of human immunodeficiency virus (HIV) and tuberculosis (TB) in order to identify radiological features associated with TB; to compare CXR features between HIV-seronegative and HIV-seropositive patients with TB; and to correlate CXR findings with CD4 T-cell count. Methods: Consecutive adult patients admitted to a national referral hospital with a cough of duration of 2 weeks or longer underwent diagnostic evaluation for TB and other pneumonias, including sputum examination and mycobacterial culture, bronchoscopy and CXR. Two radiologists blindly reviewed CXRs using a standardised interpretation form. Results: Smear or culture-positive TB was diagnosed in 214 of 403 (53%) patients. Median CD4+ T-cell count was 50 cells mm-3[interquartile range (IQR) 14-150]. TB patients were less likely than non-TB patients to have a normal CXR (12% vs 20%, p=0.04), and more likely than non-TB patients to have a diffuse pattern of opacities (75% vs 60%, p=0.003), reticulonodular opacities (45% vs 12%, p<0.001), nodules (14% vs 6%, p=0.008) or cavities (18% vs 7%, p=0.001). HIV-seronegative TB patients more often had consolidation (70% vs 42%, p=0.007) and cavities (48% vs 13%, p<0.001) than HIV-seropositive TB patients. TB patients with a CD4+ T-cell count of ≤50 cells mm-3less often had consolidation (33% vs 54%, p=0.006) and more often had hilar lymphadenopathy (30% vs 16%, p=0.03) compared with patients with CD4 51-200 cells mm-3. Conclusion: Although different CXR patterns can be seen in TB and non-TB pneumonias there is considerable overlap in features, especially among HIV-seropositive and severely immunosuppressed patients. Providing clinical and immunological information to the radiologist might improve the accuracy of radiographic diagnosis of TB. © 2012 The British Institute of Radiology.