Background: Cervical cancer is a disease in which the cells of the cervix become abnormal and start to grow uncontrollably forming tumors. It is the second most common cancer in women in Ethiopia, caused by the sexually transmitted human- papillomavirus, and in Ethiopia leading cause of cancer mortality among women aged 15 to 44 years. HIV-positive women are at an even greater risk of developing cervical cancer. Despite this tremendous burden of cervical cancer in Ethiopia, the factors were not well studied Therefore, this study aims to identify the predictors of cervical cancer among HIV-positive women. Objective: The aim of this study was to identify the determinant of precancerous cervical lesions among HIV positive women in North Wollo zone, Amhara region, Northeast Ethiopia, 2022. Method: An institution-based unmatched case-control study was conducted in selected health facilities in the North Wollo zone from March 15 to May 15, 2022. Data were collected from 85 cases consecutively until the required cases were obtained and 254 controls by systematic random sampling were selected. An interviewer-administered structured questionnaire was used to collect data from respondents. The collected data entered into Epi info version 7. then export to SPSS version 25 for analysis. Variables with P-value ≤0.25 in the simple binary logistic regression analysis was included in the multiple binary logistic regression analysis. Adjusted odds ratio with 95% confidence interval is used to identify the predictors of precancerous cervical lesions. Results: HIV positive women who had age thirty and above 4.99(95% CI: 1.62-15.45), Women who had history of age of first sex < 18 years 4.69(95% CI: 1.56-14.0). Women who had history of Sexual transmitted infection 9.69(95% CI: 4.32-21.71), rural dwellers 2.68 (95% CI: 1.2-5.9) Women who had been history of genital ulcer 2.86(95% CL1.36-6.0) and being used hormonal contraceptive 3.3(95% CI: 1.23-8.95) were the determinants of precancerous cervical lesion. Conclusion and recommendation: This study confirmed that age greater than thirty; rural dwellers, use of hormonal contraceptives, initiation of sexual intercourse < 18 years; history of Sexual transmitted infection, and history of genital ulcer were determinants of Precancerous cervical lesions. The health care provider should be focus on the prevention of cervical cancer by applying cervical cancer screening priority for HIV positive women and governments they should Strengthen Multi-sectoral Collaboration to prevent control early marriage. . Key words: Determinants, PCCL, HIV positive women Ethiopia