Studies revealed that there are various determinants of mortality among HIV positives after ART initiation. These determinants are so variable with context and dynamic across time with the advancement of cares and treatments. In this study we tried to identify determinants of mortality among HIV positives after initiating ART. A retrospective cohort study was conducted among 416 ART attendees enrolled between July 2005 to January 2012 in Nekemte Referral Hospital, Western Ethiopia. Actuarial table was used to estimate survival of patients after ART initiation and log rank test was used to compare the survival curves. Cox proportional-hazard regression was applied to determine the independent determinants of time to death. The estimated mortality was 4%, 5%, 6%, 7%, and 7% at 6, 12, 24, 36 and 48 months respectively with mortality incidence density of 1.89 deaths per 100 person years (95% CI 1.74, 3.62). Forty years and above AHR = 3.055 (95% CI 1.292, 7.223), low baseline hemoglobin level (AHR = 0.523 (95% CI .335, 0.816)), and poor ART adherence (AHR 27.848 (95% CI 8.928, 86.8)) were found to be an independent determinants of mortality. These determinants of mortality have to be taken into account to enhance better clinical outcomes of ART attendees. 1. Introduction HIV/AIDS remains one of the leading causes of death globally. It is projected to continue as a significant cause of premature mortality [1]. According to the joint 2011 HIV/AIDS report of WHO, UNAIDS, and UNICEF, an estimated 34 million people were living with HIV/AIDS globally with 2.7 million new HIV infections in 2010. Of these, 68% were residing in sub-Saharan Africa [2]. Ethiopia is one of the seriously affected countries in sub-Saharan Africa with a large number of people (approximately 800,000) that are living with HIV/AIDS and 44,751 AIDS-related deaths. An estimated number of 249,174 adults (86% of eligible) are on ART treatment [3–5]. The average life expectancy at birth is low,？ ？51 years for males and 53 years for females. It is expected to further decline if the present HIV infection rates continue [3]. Different studies from different countries reported that WHO clinical staging, viral load, age, gender, CD4 cell count, total lymphocyte count (TLC), body mass index (BMI), ART adherence, and baseline hemoglobin level were determinants of mortality [6–10]. Even though studies had identified these determinants of mortality, they are so variable with context and dynamic across time with advancement of care and treatments as many years are being spent on highly active
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