Open AccessBackground: The wide ranging clinical manifestations and pathological changes in patients infected with HIV / AIDS are both fascinating and challenging to health care professionals. OIs constitute a major health problem in patients infected with HIV. The type of pathogens responsible for morbidity and mortality vary from country to country and even from region to region within the same country. Objective: This study was designed with an aim to document the trends of opportunistic infections in HIV infected patients from rural tertiary care hospital of Western Maharashtra. Such studies have not been worked out before in this region. Methods: The study included various specimens from 142 HIV infected patients. All specimens were processed as per standard microbiological protocol for demonstration or isolation of pathogens. Results: HIV infection was more in males (62.6%). The most common clinical feature was weight loss (47.8%). Infectious agents were demonstrated or isolated in 81.6% HIV infected patients. Mycobacterium tuberculosis (44.8%) was the most common isolate followed by Candida species (23.2%). Conclusion: Opportunistic infections (OIs) are common complication in HIV infection. They cause substantial morbidity and hospitalization, necessitate toxic and expensive therapies and shorten the survival of people with HIV. Hence the early and accurate diagnosis of OIs is important.