Background: Smear negative pulmonary tuberculosis(SNPTB)leads to a serious disease tornhuman immunodeficiency virus infected patients. Therefore knowing the correct diagnosticrnmethod improves early detection of the disease.The burden of SNPTB is not known in the studyrnarea .Therefore, this study aimed to determine the burden of TB, MDR-TB, in Tulu bolo and St.rnLuke hospitals,south west shewa Ethiopia.rnObjective: To determine the burden of SNPTB using genexpert and culturernmethodsamonghuman immunodeficiency virus infected patients on ART follow up at Tulu bolornGeneraland St. Lukas Hospitals in 2012 E.C.rnMethods: A total of 197informed and consented HIV patients with suspected pulmonaryrntuberculosis who were presented with pulmonary tuberculosis sign and symptoms of at least 2rnweeks or more were screened by FM smear microscopy. All 197 HIV patientsâ€™ bothsmearrnnegative and smear positive pooled sputum samples were further tested by gene expert in Tulurnbolo general Hospital and St. Luke Hospitals. Simultaneously all smear negative patients andrnsmear positive patients were allowed to give samples which were sent to EPHI for MTB culturern(LJ and MGIT), and LPA test.All drug resistant isolates were tested by using Genotype MTBDRrnplus Ver.2 and first- line MGIT DST.Then the result was collected and data analysis wasrnperformed by the use of statistical software epiinfo version 7.2 and SPSS version 23. The studyrnwas conducted from December 1, 2019 to February 30, 2020rnResults: From the total of 197 enrolled HIV patients, 5/197(2.54%)were smear positive,19/192rn(9.9%) were Xpert MTB/ RIF and culture confirmed smear negative PTB patients. The positivityrnrate among male and female was 10/19 (52.6%) and 9/19(48.4%), respectively. From 19 culturernpositive isolates, 1 (5.26%) was MDR-TB (resistant to both Rifampicin and Isoniazid); thisrnpatient was a female patient under retreatment. Among 19 SNPTB cases14/19(73.68%) patientsrnviral load status were greater than 2001.and about 12/19(63.12%)of 19 SNPTB patients CD4cellrnresult were less than 200 cells per millimetre cubernConclusion: In this study a significant proportion of smear negative pulmonary TB wasrndiagnosed. Further, a smear negative multi drug resistant (MDR) TB was confirmed. Due to thelimitations of smear microscopy which is used as a primary diagnostic tool, these TB strains arernmissed to be diagnosed, mortality in HIV patients and transmission in the communitycontinues.