We compared the pattern and distribution of pulmonary lesion on chest radiograph of HIV patients with CD4 count < or ≥200cells/ìl and HIV-1RNA viral load < or ≥log105. Of the 133 patients consecutively recruited, 84 (63.2%) had CD4 count <200 cells/ì. Patients with CD4 count <200 cells/ì had consolidation (15.5% vs 28. P = 0.054) and streaky changes 39.3% vs 55.9%, P = 0.049) less often. Pulmonary lesions involving upper and middle radiological zones were less common in cohort with CD4 count < 200cells/ì (11.9% vs 30.5%, P = 0.006), conversely middle and lower zone involvement were most often seen in them (27.4% vs 15.3%, P = 0.008). Patients with HIV-1 RNA viral load ≥05copies/ml had nodular lesions less often (31.7% vs 55.1%, p = 0.038) and more often had hilar or mediastinal lymphadenopathy (22.0% vs 7.3%, P = 0.012). Lower zone involvement was predominantly seen in cohort with HIV-1 RNA viral load ≥05copies/ml (19.5% vs 0.01%, p = 0.000). Our study demonstrates association between HIV disease stage with pattern and distribution of certain tuberculosis lesion on chest radiograph. Knowledge of immunological and virological parameters is important to clinicians and radiologist when evaluating CXR findings in HIV-infected patients.