Objective To explore the clinical and sociological characteristics of patients with human immunodeficiency virus (HIV) infection complicated with pulmonary tuberculosis (PTB) in western ethnic minority area, analyze the risk factors affecting their prognosis, and provide basis for developing comprehensive prevention and intervention strategies in resource-limited areas. Methods 126 patients with HIV-PTB co-infection admitted to a people’s hospital in a western ethnic minority area from January 2022 to December 2023 were included in analysis retrospectively. Demographic, clinical, laboratory, imaging, and sociological data (education level, marital status, transportation accessibility, economic status) of patients were collected, and the differences between good prognosis group and poor prognosis group were compared, independent risk factors for the prognosis were analyzed by multivariate logistic regression. Results Among the 126 patients, 77.0% were male, with an average age of (40.3±9.2) years old. Multivariate logistic regression analysis showed that CD4⁺T lymphocyte cells<200 cells/μL (OR=8.59, 95%CI: 3.31-22.29), bilateral lung lesions (OR=6.23, 95%CI: 2.57-15.07), non-standard anti-tuberculosis treatment (OR=5.89, 95%CI: 2.62-13.22), and low education level (OR=3.65, 95%CI: 1.54-8.65) were independent risk factors for poor prognosis. Conclusion The prognosis of patients with HIV-PTB co-infection is not only affected by clinical factors, but also closely related to sociological characteristics. Improving treatment compliance, strengthening community support, and enhancing health education levels are of great significance for improving the prognosis of patients with HIV-PTB co-infection in remote ethnic minority area.