Background– Human immunodeficiency virus/ Acquired immunodeficiency syndrome (HIV/ AIDS) remains a major global public health problem, mainly to the sub-Saharan African countries. The consequence of HIV/AIDS is serious among malnutrition patients which have an impact on their immune system. Ethiopia is among the countries most affected by malnutrition and HIV epidemic. Knowing the nutritional status of HIV/AIDS patients and taking timely intervention is important to help patients. Objective - This study aims to assess the nutritional status and associated factors among adult HIV patients taking ART at health facilities of YlmanaDensa district North West Ethiopia. Methods –An institution based cross-sectional study were conducted among 358 adults HIV patients on ART. An exit interview was used to collect data using the interviewer administered structured, pre-tested questionnaire, and measuring the height and weight to calculate BMI. Multivariable Logistic regression analyses were used to identify factors associated with the nutritional status of patients on ART. The significance association was determined at p-value <0.05. Results: The Overall prevalence of malnutrition (BMI <18.5 kg/m2) among PLWHA on ART at Yilmanadensa hospital and health centers was 23.5%.Malnutrition was less likely [AOR 0.318(95%CI: 0.16-0.64)] among patients who had received dietary counseling during ART follow up, was more likely [AOR 10.38 (95%CI: 4.33-24.85)] among patients who were being in WHO clinical stage-II during ART follow up, and was higher [AOR 10.15 (95%CI: 3.83-26.90)] among clients who had average family monthly income less than 1500 Ethiopian Birr compared to their counterpart ART patents. . CONCLUSION: Prevalence of malnutrition is high among HIV infected adults who are on ART in the study area. Regular nutritional assessment of the patients and dietary counseling should be integrated with routine care for HIV/AIDS patients. HIV/AIDS prevention and control programs need to involve nutritionists or trained health care provider to integrate nutritional care services. Developing income generating activities and other sectorial programs are required to improve adequate meals intake of HIV positives.