**Abstract**

Antiretroviral therapy is a drug treatment that plays a great role in reduction of mortality among children infected with human immunodeficiency virus (HIV). Studies in Africa have shown that there is short survival time among children receiving antiretroviral therapy. The aims of this study were to estimate the survival time and identify associated factors among HIV-infected children after initiation of antiretroviral therapy. Institution-based retrospective cohort study was conducted among 421 children. Cox proportional hazards regression model was used to determine independent predictors. Findings of this study reveal that 261 (62%) children were alive, 43 (10.2%) were lost to follow-up, 52 (12.4%) were transferred out to other facilities, and 65 (15.4%) were reported to have died, and overall prevalence of malnutrition among respondents was 23.7% (95% CI, 19.13–28.27%). Multivariable analysis showed that nutritional status (adjusted hazard ratio (AHR) = 4.1, 95% CI = 2.41–6.9), absolute CD4 count below threshold (AHR = 2.3, 95% CI = 1.32–3.88), fair and poor adherence to antiretroviral therapy (AHR = 0.4, 95% CI = 1.66–6.9), (AHR = 3.3, 95% CI = 1.73–6.23), isoniazid prophylaxis (AHR = 0.4, 95%, CI = 0.21–0.65), and co-trimoxazole prophylaxis (AHR = 0.3, 95% CI = 0.14–0.44) were independent predictors of the survival time. Therefore, children living with HIV should be encouraged to adhere to the antiretroviral therapy and take co-trimoxazole and isoniazid preventive therapies.

**Keywords:** antiretroviral therapy, co-trimoxazole preventive therapy, isoniazid preventive therapy, children, Ethiopia
