Aim
To determine the relationship between the chest radiographic patterns of PTB and CD4+ cell count among HIV-infected patients at FMC Katsina, Nigeria.

Background
The diagnostic usefulness plain chest X-ray (CXR) for patients with HIV/PTB co-infection is dependent on the degree of immunosuppression.

Materials and methods
We obtained and analysed, retrospectively, the hospital records of 182 patients treated for PTB with or without HIV infection at FMC Katsina, between 1st of January to 31st December, 2010. The Chest radiographic (CXR) features of PTB were reported as typical or atypical. Ziehl–Neelsen stained smear results were also used.

Results
Of the 182 patients’ records used for this study, 102 (56.0%) males and 80 (44.0%) females with mean age of 40.2 ± 15.6 years and range of 18–85 years. The CXR of 182 patients recorded showed that 140 (76.9%) have typical features of PTB with 42 (23.1%) reported as atypical features. Those with HIV/PTB co-infection showed significantly higher atypical CXR features (p = 0.000) and even based on their CD4 cell count (p = 0.017).

Conclusion
Atypical chest radiographic features are commoner among HIV-infected PTB patients, especially those with low CD4+ cell counts, who also have low sputum smear yield. Providing facilities for TB culture in health care centres in Nigeria may reduce misdiagnosis.