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Abstract Background: Substitution of long-term ART exposed to HIV/AIDS patients are common due to the ART adverse event. The study aim is to describe the reason of ART substitution among HIV/AIDS patient at Sanjiwani Hospital Bali. Methods: A retrospective study has conducted to the medical records of HIV/AIDS patients at Sanjiwani hospital Bali, during 2006-1018. Clinical data retrieved from the medical records and presented as descriptive data. Results: Over a twelve-year period, 1112 HIV/AIDS patients evaluated in the study. The ART regimen were Zidovudine-based ART, Tenofovir-based ART and Stavudine-based, for 12.2%, 87.3%, 0.5%, respectively. There were 2.2 % switching of ART during the study periode. The most reason was anemia (48%), followed by reducing of kidney function (28%), allergic reaction (16%), and 4% of nausea and suspected clinically failure to ART. Conclusion: We highlight that anemia is the main reason of ART substitution among HIV/AIDS patients