Low CD4 counts at first presentation remain a significant indicator of delayed HIV diagnosis and increased risk of adverse outcomes. Early identification of patients at risk for late presentation is essential for improving diagnosis, linking individuals to timely treatment and guiding targeted public health interventions.This study aims to determine sociodemographic, behavioural and clinical characteristics associated with baseline CD4 counts <200 cells/µL among newly diagnosed HIV patients attending a primary care clinic in Bintulu.A retrospective analysis was conducted among HIV-positive individuals who received care between 2020 and 2024. Data were extracted from medical records using a standardized form, including age, gender, ethnicity, body mass index, sexual orientation, clinical presentation, and baseline CD4 count. Patients with incomplete baseline information were excluded. Descriptive statistics summarized demographic and clinical characteristics. Univariable logistic regression was used to identify potential predictors, followed by multivariable logistic regression to determine independent associations with low CD4 count, reported as adjusted odds ratios with 95% confidence intervals.A total of 194 records were included. The mean age was 29.6 ± 6.3 years, with the majority aged 21–30 years (57.2%) and male (90%). Most patients had normal BMI (55.7%), 25.3% were overweight and 8.5% underweight. Ethnic distribution showed 56.7% Iban, 27.4% Malay and 10.3% Chinese. More than half (55.2%) identified as homosexual and 41.2% reported multiple sexual partners. Clinically, 39.6% were asymptomatic, 31% were screened due to other STIs, 25.3% presented with general symptoms and 4.7% had opportunistic infections. Overall, 40.7% had baseline CD4 <200 cells/µL. Univariable analysis identified age 21–30 years, Iban ethicity, general symptoms and opportunistic infections as associated with low CD4 count. Multivariable analysis confirmed general symptoms and opportunistic infections as independent predictors.These findings align with global evidence showing that symptomatic presentation and opportunistic infections strongly predict late HIV diagnosis (UNAIDS, 2023; WHO, 2022; Cohen et al., 2016). The high proportion of advanced disease underscores persistent delays in testing among young MSM populations.HIV-related symptoms and opportunistic infections were strong independent predictors of low baseline CD4 counts. Strengthening early testing, targeted outreach and community awareness is essential to reduce late presentation and improve clinical outcomes.