Full text Article. Also available at https://doi.org/10.1155/2017/7075601Introduction. HIV still causes high mortality despite use of ART. This study was designed to determine the prevalence and risk factors of mortality among HIV patients receiving ART in north western rural Tanzania. A retrospective study of HIV patients on ART was done at Sengerema in Mwanza, Tanzania. The data on demography, date of HIV diagnosis, WHO stage, opportunistic infections, CD4, hemoglobin, ART regimen,and time and outcome on treatment as dead or alive were collected and analyzed using STATA version 11. In total, 740 patients were studied. The median age was 35 (27–42) years with female predominance of 465 (62.8%). Of the participants, 261 (35.3%) had WHO stages 3 and 4 diseases. Most participants, 258 (34.9%), had baseline CD4 counts <200 cells/𝜇l. Deaths occurred in 86 (11.6%) patients which were independently associated with male gender (16.0% versus 9.0%, 𝑝 = 0.015), being divorced (OR=2.7,𝑝 < 0.001), WHO stages 3 and 4 (OR=2.3,𝑝 = 0.05), CD4<200 cells/𝜇l (OR=3.4, 𝑝 < 0.001), and severe anemia (OR=6.6, 𝑝 < 0.001). The mortality is high among HIV patients receiving ART in north western rural Tanzania. Universal testing could increase early diagnosis and treatment. A close follow-up ofat-risk patients within the first year of ART could reduce the mortality of this sub group of patients.