The radiological appearances of active tuberculosis in human immunodeficiency virus (HIV) positive patients was reviewed. A study group of 61 Black HIV positive patients and a control group of 50 Black HIV negative patients were analysed. The chest radiographs of the HIV seropositive group showed a significantly higher percentage of lymphadenopathy (50%), pleural effusions (38%) and miliary (8%) or interstitial patterns (11%), as compared with those in the seronegative group (8%, 20%, 0% and 4% respectively). Cavitation (38%) and atelectasis (31%) were less common in the seropositive group than in the seronegative group (82% in each category). Thus in an endemic TB environment an awareness of this difference in appearances will allow the radiologist to alert the referring clinician to the possibility of concomitant HIV seropositivity.