Introduction: Tuberculosis (TB) and human immune deficiency virus (HIV) infections are two major public health problems of the world. TB is the leading killer among people a common condition in infected with HIV. The government of Ethiopian has adapted and employed different strategies to reduce TB incidence among people living with HIV, TB free survival of HIV infected individual after ART initiated is not well researched. Objectives: This study aimed to assess time to develop active TB and its predictors following antiretroviral therapy (ART) initiation among HIV patients in South Gondar Zone. Methods: A retrospective cohort study was conducted using a checklist to gather data from 538 randomly selected adult HIV positive individual on ART. The data extraction format was developed from the standardized ART entry and follow up forms that currently used by the ART clinics. Data was cleared and entered into Epi-data version 3.0 and exported to STATA version 14.1 for further statistical analysis. TB free Survival estimates was calculated using Kaplan Meier product limit estimator method and comparisons were done using log rank test. Bi-variable and multivariable Cox proportional hazard model was used to explore significant variables. Results: A total of 538 patients were followed and produced 2021.983 Person-Years (PY) of observation. The overall TB free survival probability was 0.86 at one years and 0.79 at five years. It is found that there is a difference in TB free survival experience between categories of covariates. A total of 108 active TB cases were observed during the follow up period. Hence, the incidence density rate in this cohort was found to be 5.3 per 100 PY (95% CI: 4.4-6.4). Being in ambulatory functional status (AHR=2.39 95% CI: 1.07-5.32), WHO clinical stage III (AHR=5.58 95% CI: 1.81-17.18), stage IV (AHR=5.52 95% CI: 1.55-19.61), CD4 count between 101-200cell/µl (AHR=2.87 95% CI: 1.02-8.10) and poor ART treatment adherence (AHR=3.81 95% CI: 1.63- 8.94) were predictors of TB occurrence after initiation of ART. Conclusions: Incidence of TB among PLHIV after ART initiation was lower compared to previous studies conducted in Ethiopia. While high TB incidence were observed in the first year of ART follow up period and among patients having advanced disease stage. As a rule intensified screening is highly recommended during ART treatment follow up for those who have advanced disease stage. Strengthen ongoing adherence and positive living counseling also recommended. Keywords: Survival to develop TB, after ART initiation, people with HIV, South Gondar Zone