Introduction: Survival is low among non-treated patients. The time to survive after ART initiation has not been adequately studied. Thus, this study was aimed to determine survival status and associated factors among HIV positive adults on antiretroviral treatment in Debre Markos Referral Hospital, Northwest Ethiopia.

Methods: Facility-based retrospective cohort study design was conducted from September to February 2013. Data were collected from 640 patients' registration card in Debre Markos Referral Hospital who enrolled for treatment from 2005 to 2013. Kaplan-Meier survival curves and Log-Rank test were used to compare the survival times of different groups of patients.

Results: A total of 640 patients followed for median of 58 months and 261 patients died during the follow up period. Over all estimated mean survival times of patients was 65.22 (95%CI: 61.409-69.043) months after initiation of treatment. Baseline hemoglobin <10g/mm3, (AHR=1.869, 95%CI: 1.319-2.649), baseline ambulatory functional status (AHR=2.727, 95%CI: 1.905-3.905), bedridden functional status (AHR=2.382, 95%CI: 1.326-4.279), baseline WHO staging III and IV (AHR=2.164, 95%CI: 1.101-4.258), recent ART adherence (AHR: 2.169, 95%CI: 1.030-4.567) and fair adherence (AHR=1.887, 95%CI: 1.081-3.295) were associated with survival of the patients.

Conclusion: The Kaplan-Meier results showed that the general mean estimated survival time of patients after Highly Active Anti Retroviral Therapy (HAART) initiation was improved. But low baseline hemoglobin, ill-health functional status, poor ART adherence were negatively associated with lesser survival of patients.