〔Abstract〕 Objective To analyze the features and manifestations of computed tomography (CT) imaging in patients with acquired immune deficiency syndrome (AIDS) and pulmonary tuberculosis. Methods The 40 patients with AIDS and pulmonary tuberculosis admitted to Hanshou County People's Hospital from September 2017 to September 2019 were selected as the observation group, and 40 patients with pulmonary tuberculosis admitted to this hospital during the same period were selected as the control group. CT imaging examinations were performed on both groups of patients, and the CT imaging manifestations and characteristics of the two groups were observed and compared. Results There was no statistically significant difference between the two groups of patients in the incidence of involvement of both lungs, two lobes and more than two lobes, and the posterior segment of the upper lobe apex and the dorsal segment of the lower lobe (P > 0.05). The incidence of lymph node or pleural involvement in the observation group was higher than that in the control group, and the difference was statistically significant (P < 0.05);The incidence of patch or large-scale consolidation, pleural effusion, mediastinal lymph node enlargement, and pericardial effusion in the observation group were higher than those in the control group, and the difference was statistically significant (P < 0.05). The incidence of largescale consolidation and multiple cavities in the observation group was lower than that in the control group, and the difference was statistically significant (P < 0.05). There was no statistically significant difference in the incidence of simple voids and multiple nodules between the two groups of patients (P > 0.05). Conclusion CT imaging examination can distinguish AIDS patients with pulmonary tuberculosis from patients with simple pulmonary tuberculosis. After CT imaging examination, the patient’s imaging performance is more prominent, which can provide clinicians with image data for diagnosis and provide guidance for the treatment of patients, having high clinical application value.