Acquired Immunodeficiency Syndrome (AIDS) is one of the most fatal infectious diseases in the world, especially in resource-limited settings like Sub-Saharan Africa. Tuberculosis (TB) is a major cause of morbidity and mortality among HIV-infected individuals, and Ethiopia is one of the 30 countries with a high TB burden. Even though antiretroviral therapy (ART) significantly decreases TB and mortality overall, death rates are still highest, especially in the first year of ART initiation. This study aimed to assess the incidence and predictors of TB and early mortality among adults on antiretroviral therapy at Debre Markos Referral Hospital, Northwest Ethiopia, in 2019.