The only available treatment for Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) at the moment is antiretroviral therapy (ART). The chest radiograph patterns in adults with HIV could be used as an alternative or surrogate to CD4 count in monitoring the progress of treatment in resource poor settings where these tests and expertise are not available. This study was aimed at evaluating chest the radiograph patterns in HIV sero-positive adults and correlating with the CD4 cells count. This was a cross-sectional study conducted among patients diagnosed of HIV using the National algorithm at the HIV Clinic of the Lagos University Teaching Hospital. A purposive sampling method was employed and three hundred and twenty (320) HIV sero-positive adult participants were recruited. Postero-anterior chest x-ray projection was performed on all the participants and the radiographs were reported by two consultant Radiologists and the CD4 counts was determined. Pulmonary TB was the most frequent finding (22.1%) while bronchitis was the least frequent finding (0.9%). and normal radiograph (52.6%). The CD4 count was less than, 200 cells/mm3 in 38.3% of the participants. There was a strong correlation between chest radiograph patterns and CD4 cells count (r=-0.53; p=0.001). This study revealed that the most predominant radiographic patterns are Pulmonary Tuberculosis. A strong negative correlation was observed between chest radiograph patterns and CD4 count. The Chest radiograph patterns may be recommended as a measure of immunosuppression in adults with HIV in Nigeria.