Urinary tract infections (UTIs) represent a major public health concern, with over 10 million cases reported annually in India. Among resource-limited tribal populations, such as the Naga communities of Nagaland, restricted access to healthcare and reliance on traditional medicine may exacerbate UTI risk. This cross-sectional study assessed UTI prevalence, uropathogen distribution, antibiotic resistance patterns, and the relationship between peripheral CD4⁺ T-cell counts and UTI susceptibility among 250 HIV-negative Naga adults aged 18–65 years. Out of these, 94 individuals tested positive for UTI (≥10⁵ CFU/mL), while 156 asymptomatic participants acted as controls. CD4⁺ counts were determined using flow cytometry, and urine samples were cultured following CLSI-standard microbiological protocols. The overall UTI prevalence was 37.6%, significantly higher in females (47.2%) than in males (25.0%; p = 0.0004). Mean CD4⁺ T-cell counts were markedly lower in UTI cases (406 ± 82 cells/mm³) compared with controls (689 ± 105 cells/mm³; p < 0.0001), with infection rates increasing sharply below 400 cells/mm³. Escherichia coli was the predominant pathogen (64.9%), with 39% of isolates showing multidrug resistance. Multivariate analysis revealed that rural residence, advanced age, and dependence on traditional remedies are independent risk factors (OR 1.95–2.73; p < 0.05). These findings demonstrate a strong inverse association between CD4⁺ T-cell levels and UTI susceptibility, pointing to the importance of integrated strategies combining immunological screening, antibiotic stewardship, and culturally sensitive health education in tribal healthcare programs.
