Dissertation (MMED General Surgery)Human Immunodeficiency Virus, a cause of Acquired immunodeficiency syndrome (AIDS) is becoming a concern to most Surgeons. Tanzania is listed in the top 10 countries most affected by HIV in sub-Saharan. Iringa region is mentioned the second in top 3 regions most affected in Tanzania.So far the burden of HIV in patients undergoing Emergency Laparotomy in Tanzania has not been clearly audited. This is a Hospital-based Prospective Cohort study design involving HIV infected patients who had Emergency Laparotomy at Iringa regional hospital, from 1st June 2017 to 31stMarch 2018. Data was collected using convenient sampling via direct observation and questionnaire. Each subject was evaluated for a period of 30 days postoperatively. Statistical Package for the Social Sciences (SPSS) version 20 through logistic regression used for data processing and analysis; a P value of < 0.05 at 95% confidence interval was considered of statistical significance. There were 63 HIV infected patients obtained, an estimate of 23.9%, only 62 patients were involved in the analysis, Perforation was the major cause of Emergency Laparotomy at 43.5%, and 38.7% had bowel Resection and Primary Anastomosis. Morbidity and Mortality were 56.5% and 17.7% respectively dominated by Pneumonia (35.5%) and surgical site infection(29%). Patients who had Resection and Primary Anastomosis were 16.8 times more likely to develop poor early outcome of Emergency Laparotomy, than those who underwent other procedures and Patients who were not on Antiretroviral therapy were 58.9 times more like to develop poor outcome than patients who used Antiretroviral therapy.