Background: Despite availability of antiretroviral therapy, HIV is responsible for 2.7 million new infections and 2.0 million deaths from worldwide. Anti-Retroviral treatment failure is not a commonly diagnosis in healthcare facilities in Ethiopia and there is dearth of information on the extent and predictors of treatment failure among adults receiving HIV care in the study setting. The aim of the current study is to assess the incidence and predictors of Anti-Retroviral Treatment (ART) failure among adults receiving HIV care at Zewditu Memorial Hospital, Addis Ababa, Ethiopia.Methods: Facility based retrospective cohort study design was employed on archived data from 2011 to 2016. Data compilation checklist was developed from intake card and ART follow-up card. The collected data were coded and entered using Epi Info 7 and analysed using Statistical Packages for Social Science (SPSS) version 20 software. Results:The overall incidence rate of ART treatment failure were 4.91 cases per person months follow up with 2.1, 0.24 and 0.13 immunological, clinical and virological treatment failure cases per 100 person years of follow-up respectively Conclusion:The incidence of Anti-Retroviral Treatment failure was considerable among the study participants. The predictors for ART failure were WHO stage 3 at start, CD4 count at base line, disclosure and opportunistic infections. Comprehensive interventions have to be in place to tackle treatment failure among adults on ART through rendering optimum care focusing on adults with advanced WHO stage, lower CD4 count at baseline, opportunistic infections and people who did not disclose their HIV status.

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