According to 2011 Ethiopian demographic health survey the national adult HIV prevalence is 1.5 %. In the same survey, HIV prevalence was 2.2% in the Amhara Region. In the region of North West Ethiopia, 88.9% of pre-ART PLWHA has any type of OI at initiation of ART. Different studies showed the effect of ART improves time to death of PLWHA however, little is known about its effect on improving time of recurrence of OI and factors associated with it and magnitude of the recurrence. Hence this study will be used to plan resources needed for chronic HIV/AIDS care and to identify factors affecting patients’ survival. Objective: To assess time to recurrence of OIs and factors associated with it and to determine magnitude of recurrence in PLWHA in Debre Markos town in 2013. Method: Institution based comparative retrospective cohort study were used and the required sample size was 536. All 18 years old and above PLWHA who were on chronic HIV care in Debre Makkos town health institutions was the source population for the study. Study participants were selected from the list of PLWHA attending the public health facilities using simple random sampling procedure by data collectors who are working in ART clinic. Univariate analysis was used to describe patients’ baseline and follow up characteristics. Actuarial life table and Kaplan-meier survival was used to estimate survival and log rank test was used to compare survival curves. Cox proportional-hazard regression model was used to calculate the uni-variate and adjusted hazard rate and to determine independent predictors of time to recurrence of OI. Result: Among study participates 66% were females and the median age was 32 years. Most of them were urban 70.1%, orthodox 92.4%, not educated 44%, married 43.3% and employed 20%. During a median of 43 person weeks follow up OIs recurred in three quarter (75.7%) study participants. The Incidence rate of OI recurrence was 13.1(95 CI: 11.9-14.5) per 1000 person weeks. Using the Kaplan-meier survival estimation the median time of survival was 57 weeks. After adjusted for covariates the significant predictors for survival were marital status, occupational status, follow up CD4 count, base line Hgb value, ART exposure status, base line ART adherence status, base line and follow up prophylaxis exposure status and follow up prophylaxis adherence status, Conclusion and recommendation: Governmental and non-governmental organizations working on HIV/AIDS should give especial attention for risk groups like widowed, not taking treatment/ adhere ART or prophylaxis while continuing HIV care for all PLWHA.