BACKGROUND: Hypocholesterolaemia in pulmonary tuberculosis(TB) patients is disregarded but is a predictor of poor survival. OBJECTIVES: To determine serum lipid profile differences at diagnosis and various times of medication based on sex, HIV(human immune virus) and wasting status and factors associated with hypocholesterolaemia. METHODS: A repeated cross-sectional study was conducted to assess triglyceride(TG), total cholesterol (TC), high-density lipoprotein(HDL) and low-density lipoprotein(LDL) among 414 participants. RESULTS: Majority of the participants were males(239/414)(58%), with a median age of 28years. TB patients showed significantly lower lipid profile at diagnosis regardless of HIV-status and sex. Presence of anaemia among HIV-seropositive participants with TB, prevalence ratio(PR):2.6, 95%confidence interval(CI):1.0-7.1, p<0.05) and HIV-seronegative participants with TB(PR:2.5, 95%CI:1.1-5.5, p<0.05), moderate/severe TB(PR:2.5,95%CI:1.1-5.5, p<0.05) and CD4 cells>200(PR:0.3 95%CI:0.1-0.8, p<0.05) among HIV-seropositive participants with TB were associated with HDL-hypocholesterolaemia. Male sex, moderate/severe TB, body wasting, dyspnoea and chest pain were independently associated with TC-hypocholesterolaemia. Regardless of sex and wasting status, the pattern of cholesterol recovery was similar at varying times. CONCLUSION: We envisage that hypocholesterolemia is a marker of clinical TB-disease severity and its recovery indicates treatment response.