Introduction: Anti-retro viral therapy regimen discontinuations become a big challenge and cause diminishing the clinical and immunological benefit of treatment in Ethiopia. It reduces both the duration and the chance of viral control due to cross resistance between different alternative drugs and overlapping toxicity between and within a class of antiretroviral drugs in Ethiopia. However information’s on time of initial regimen discontinuation and its predictors are not well studied Objective: The aim of this study was to assess the time to initial highly active antiretroviral therapy discontinuation and its predictors among HIV patients in Felege Hiwot comprehensive specialized hospital, North West Ethiopia. Method: Institution based retrospective cohort study was conducted among 418 HIV patients started HAART from January 1, 2014 to December 31, 2019. Simple random sampling technique was used. Data were collected from patient chart using data extraction tool. The Kaplan–Meier curve was employed to compare survival rates. Multivariable Cox proportional hazard regression was applied to identify independent predictors of time to initial regimen discontinuation. Cox PH model fitness was checked using schoenfeld residuals test and the log-log plots. Result: A total of 418 patients on anti-retroviral therapy were followed. Incidence of initial HAART discontinuation was 16.7/100 Person year. The median survival time was 3.5 years. Predictors showed association for time to initial HAART discontinuation were taking >1 ART pills/day (AHR = 4.1, 95% CI: 3.0-6.5), baseline CD4 count <100 cells/mm3 (AHR = 2.6, 95% CI: 1.5-4.7), 100-199 cells /mm3(AHR = 2.2, 95% CI: 1.2-4.0), baseline WHO clinical stage IV (AHR = 2.68, 95% CI: 1.6-4.3) and stage III(AHR = 2.6, 95% CI: 1.4-4.3) and TB infection (AHR = 2.3, 95% CI: 1.6-3.5). Conclusion: Most of the discontinuation occurred after one year of initiation of HAART. Baseline WHO clinical stage, TB infection, baseline CD4 count and taking > 1 ART pill/day were found predictors of initial HAART regimen discontinuation. Work on early detection of HIV before the disease is advanced, initiation of one ART regimen in a daily basis and work in collaborate to prevent TB burden on PLHIV is important for survival on initial regimen. Key words: Initial HAART discontinuation, survival time, HIV, Bahir Dar, Ethiopia