Abstract: Objective To analyze the testing results of T lymphocyte subsets and viral load in newly  human immunodeficiency virus (HIV) antibody -confirmed positive cases in Suzhou (2021–2024), and to investigate their demographic characteristics, immune status, and viral replication patterns, thereby providing evidence for HIV/acquired immune deficiency syndrome (AIDS) prevention and control. Methods Peripheral blood samples were collected from newly confirmed HIV-positive cases in Suzhou from 2021 to 2024. T lymphocyte subset analysis and viral load testing were performed, and influencing factors were identified in combination with demographic characteristics. Multivariate and correlation analyses were performed using logistic regression models and Spearman’s test. Results Among the 3 022 confirmed HIV-positive samples, the median CD4⁺T lymphocyte count was 298.00 cells·μL^-1, with 882 cases (29.19%) showing CD4⁺ counts <200 cells·μL^-1. The median CD8⁺T lymphocyte count was 1 011.00 cells·μL^-1. The median CD4⁺/CD8⁺ ratio was 0.28. 32.46% of cases exhibited CD4⁺/CD8⁺ ratios <0.20, and there were statistically significant differences in the distribution of CD4⁺/CD8⁺ ratio among different genders, age groups, marital status, and sample sources (all P<0.05). Multivariate logistic regression analyses indicated that age ≥20 years, being divorced or widowed, and hospital-based sample sources were influencing factors for initial CD4⁺ T lymphocyte counts ≤350 cells·μL^-1. The mean lg viral load was (4.29±1.15) copies·mL^-1. Viral load levels demonstrated a significantly negative correlation with both CD4⁺/CD8⁺ ratio (r =-0.430, P<0.001) and CD4⁺ T lymphocyte count (r =-0.372, P<0.001). Conclusion A substantial proportion of newly diagnosed HIV/AIDS cases in Suzhou are late presenters. Targeted interventions should prioritize high-risk populations through enhanced active surveillance, expanded testing coverage, and the implementation of combined T lymphocyte subsets analysis and viral load testing, which can optimize prevention and treatment strategies, thereby enabling earlier case-finding and timely antiretroviral therapy initiation.