Background The European Late Presenter Consensus Working Group, defines “late presentation” as initial presentation to HIV care with a CD4 cell count of <200 cells/μl. Globally, 36.9 million people were living with HIV, African region remains most severely affected, with nearly 1 in every 25 adults. In 2017, around 940,000 people died from AIDS-related illnesses worldwide.Methods Hospital based case control study was conducted from Nov 2018-June 2019 in public hospitals of Mekelle city. Using simple random sampling technique 114 cases and 229 controls were included in the study. Data was coded and entered to Statistical Package for Social Science version 23 for data analysis. Variables with p-value<0.25 in bivariate logistic regression were selected for multivariable logistic regression to identify factors of HIV presentation. Odds ratio was estimated with 95% CI to show strength of association and p-value <0.005 was used to declare stastical significance in multivariable analysis. Results was summarized and presented by tables, and charts. Percentage, frequency, standard deviation and mean was calculated.Result The mean age among cases, controls was 39.7(sd + 11.5), 34 (SD+10.2) respectively. Prior HIV related teaching before enrolment to care 3.48(AOR=3.48(1.57-7.70), having symptoms while starting care 3.85(AOR=3.85(1.91-774), presence of chronic illness 4.59(AOR=4.59, 95%CI: 2.17-9.74) and Being challenged during care 1.84(AOR=1.84, 95%CI: 0.13-0.77) were independent predictors of late presentation to HIV care and support.Conclusion and recommendation Prior HIV related teaching before enrolment to care, symptom while starting care, presence of chronic illness and challenge faced during care were significantly associated with late presentation. It is better to give emphasis in providing prior HIV related teaching and cousling.