Background: Anemia is a major public health problem that affects an estimated 1.62 billion people worldwide which equivalent to 24.8% the population. Few cross-sectional studies have been conducted on anemia and human immuno-deficiency virus. However, it cannot address the incidence and predictors of anemia among human immuno-deficiency virus [HIV] infected adults. Objective: To assess incidence and predictors of anemia among adults on human immuno deficiency virus care at Debre Tabor General Hospital ART clinic, 2020. Methods: An institution-based retrospective cohort study was conducted among 434 HIV posi tive adults that have follow up from the 1st of January 2015 to the 30th of December 2019 at De bre Tabor General hospital. Computer-generated simple random sampling technique was em ployed to select the study participants. Ethical clearance was obtained from Institutional Review Board College of Medicine and Health Science, Bahir Dar University and also, I got permission letter from the concerned bodies in the hospital. Data were entered using Epi-data version 3.1, and analyzed by using STATA version 14.0. A Kaplan Meier survival curve and log rank test were used. Bivariable and Multivariable Cox proportional hazards model were fitted. Results: The overall incidence density rate of anemia during study period was 6.27 (95% CI: 0.051, 0.077) per 100-person year. clinical stage III/IV (AHR=1.04; 95% CI=1.02, 1.06), Body Mass Index less than 18.5 kg/m2 (AHR=3.11; 95% CI= 1.56, 6.22), serum creatinine greater than 1.1 IU/L(AHR=2.07; 95% CI= 1.12, 3.81), fair/poor level of adherence(AHR=1.05; 95% CI= 1.03, 1.07) and anti-tuberculosis treatment (AHR=2.47; 95% CI= 1.10, 5.54) were statisti cally significant predictors of anemia while increased anti-retroviral treatment duration (AHR= 0.98; 95% CI= 0.97, 0.99) decrease the risk of anemia at 95 % confidence level. Conclusion and recommendation: The overall incidence density rate of anemia was high. So that, prevention measures should be taken beside with HIV care especially, within 6-months ART initiation. Patients with clinical stage III/IV, under nutrition, serum creatinine greater than 1.1 IU/L, fair/poor level of adherence and taking anti TB treatment had significant predictors of anemia while increased anti-retroviral treatment duration decrease the risk of anemia. Key word: Incidence, anemia, adults with HIV; antiretroviral therapy; Debre Tabor, 2020