Introduction: The benefits of highly active antiretroviral therapy in the treatment of HIV infection have been well described including viral suppression, CD4 lymphocyte repletion, and durable reductions in AIDS related opportunistic diseases and death. However, the durability of the effectiveness of HAART remains to be delineated. Factors that limit the success of HAART include poor therapy adherence, regimen complexity, viral resistance, drug tolerability and toxicity, therapy costs, and presence of comorbid conditions such as substance abuse and addiction. The optimal time to start treatment for HIV/AIDS has been a contentious issue since the introduction of Highly Active Antiretroviral Treatment. Objective: To assess survival in PLWHA and started ART treatment in Durame and Hosanna hospital Methodology: A retrospective longitudinal study was conducted in Durame and Hosanna hospital. Patient’s records enrolled between august, 2006 to July, 2010 was reviewed by using patients ART unique identification number as a reference and the total sample size of the study was 481. Univariate analysis was used to describe patient’s baseline characteristics. Actuarial table was used to estimate survival after initiation of ART, and log rank test was used to compare survival curves. Cox proportional-hazard regression was used to calculate the bivariate and adjusted hazard rate and then determine independent predictors of time to death. Result: Four hundred eighty one patients on ART were followed for a median of 24 month (IQR 13, 40). The mean age was 36.4 and the median weight of the cohort at the initiation of ART was 52kg (IQR, 48-57kg).The median CD4 count was 154cells/μl (IQR, 102-224). The estimated mortality was 7%, 8%, 11.3 %, 15.7% and 21% at 6, 12, 24, 36 and 48 months respectively. After adjustment, the independent significant predictors of death in patients living with HIV/AIDS after initiation of ART remain poor ART adherence(AHR=5.09[95%CI=5.51, 49.48]),Advanced WHO staging (AHR=1.5[95%CI= (1.18, 2.16]), positive TB test (AHR=3.9[95%CI= 1.89, 8.07]), not married or single (AHR=10.27[95%CI=1.35, 78.3), male gender (AHR=1.704[95%CI= 1.23, 2.24])and older age(AHR=1.45[95%CI=1.1,1.96). Conclusion: This study demonstrates that simple laboratory and clinical data, available to health care providers prior to ART initiation, can predict which patients are at increased risk of death when they start therapy.