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Objective: The study aimed to investigate the clinical and computed tomography (CT) features in Chinese lung cancer patients with human immunodeficiency virus (HIV) infection. Patients and methods: This study included 33 consecutive lung cancer patients with HIV infection. Clinical data were collected, and CT features were reviewed and measured blindly. The factors associated with stages of cancer and the CT features with opportunistic pulmonary infections (OPIs) were also analysed. Results: Twenty-nine patients were male (87.9%), and the mean age was 57.7 years. The mean CD4 count was 310 cells/μl, and 18 patients received highly active antiretroviral therapy (HAART). An OPI was common (45.4%). The major histological type (87.9%) was non-small cell lung cancer (NSCLC), and 12 patients with NSCLC (41.4%) were in stages Ⅲb and Ⅳ. The NSCLC patients with an OPI were more common in the advanced stages compared to those patients without an OPI (p = 0.03), while the CD4 count level and HAART or not did not differ in the early and the advanced stages (p = 0.49; p = 1.00). The average size of tumours was4.4 cm. The tumours with an irregular shape and a larger size were associated with OPIs (p = 0.03; p = 0.07), though there was no statistical difference in the latter. Conclusions: The persistent existence of locally irregular large lesions in middle-aged males with HIV infection and a history of OPIs should be an alert for lung cancer, and clinical management is needed.