To compare findings of active pulmonary tuberculosis on computed tomography (CT) and high-resolution computed tomography (HRCT) scans in patients without the human immunodeficiency virus (HIV) and patients with HIV, and to define the spectrum of pulmonary tuberculosis in patients with HIV according to the CD4 T cell status, 76 patients (47 patients without HIV and 29 patients with HIV) with newly diagnosed pulmonary tuberculosis were studied retrospectively. The diagnosis of active pulmonary tuberculosis was based on acid-fast bacilli (AFB) in sputum culture. All patients underwent CT within 1 month of diagnosis. Patients with HIV demonstrated significantly less cavitation and bronchial wall thickening (24% vs. 49% [p < 0.05]; and 14% vs. 45% [p < 0.01], respectively) than the combined group of patients with HIV. Centrilobular nodules were significantly less common in patients without HIV (14% vs. 45%, p < 0.05). Lymphadenopathy with low attenuation centers was significantly less frequent in the patients with HIV (3% vs. 15%, p < 0.05). In patients with HIV, cavitation, lymphadenopathy, as well as the the number of nodules and the number of lobes involved correlated well with the CD4 levels. Two patients with less than 50 CD4 T cells/mm3 had normal chest CT results. Atypical chest CT patterns are frequently encountered in patients with HIV. Knowledge of these CT patterns may assist in the diagnosis and follow-up of patients with HIV with known or suspected pulmonary tuberculosis.