Objective To understand the death and attrition of HIV-infected patients with initial antiretroviral therapy in Qinzhou City, Guangxi from 2008 to 2018 and their influencing factors. MethodsA retrospective cohort study method was used to select HIV-infected people who started antiretroviral therapy(ART) in Qinzhou City from 2008 to 2018 from the Comprehensive AIDS Prevention and Control Information System, and the Cox proportional hazard regression model was used to analyze their death and attrition and their factors. Results A total of 7 812 HIV-infected patients entered the cohort. The overall mortality and attrition rate were 3.25/100 person-years and 2.41/100 person-years, resp. The mortality rate and attrition rate within the first year of antiviral treatment were 5.70/100 person-years and 4.88/100 person-years, resp. The results of Cox regression anal. showed that the influencing factors of death were age ≥50 years(HR=2.60, 95%CI: 2.27-2.98), male(HR=1.90, 95%CI: 1.62-2.23), i.v. drug use(HR=1.84, 95 %CI: 1.56-2.17), the WHO clin. stage before treatment was III/IV(HR=1.33, 95%CI: 1.15-1.53), the CD4+T lymphocyte count before treatment was less than 200/μL(HR=1.58, 95 %CI: 1.25-1.99), the treatment institution was at the county level(HR=2.74, 95%CI: 2.36-3.19), the interval between HIV diagnosis and antiviral treatment was> 30 days and <90 days(HR=1.17, 95%C: 1.01-1.36), the number of days between intervals was greater than 90 days and less than or equal to 365 days(HR=1.21, 95%CI: 1.02-1.44). Factors affecting attrition were age ≥50 years old(HR=1.60, 95%CI:1.37-1.87), male(HR=1.56, 95%CI: 1.32-1.85), i.v. drug use(HR=1.96, 95%CI: 1.62-2.36), CD4+T lymphocyte count before ART≥350/μL(HR=1.43, 95%CI:1.16-1.77), the initial antiviral treatment regimen contains LPV/r(HR=1.80, 95%CI: 1.36-2.38), antiviral treatment started in 2013-2016(HR=1.36, 95%CI: 1.12-1.65), antiviral treatment started in 2017-2018(HR=1.66, 95%CI: 1.30-2.14), the number of days between HIV diagnosis and antiviral treatment>365 days(HR=1.21, 95%CI: 1.01-1.45). Conclusions The antiviral treatment effect of HIV-infected patients in Qinzhou City is more significant, but the mortality and attrition rate are higher within the first year of treatment. It is necessary to strengthen the training of antiretroviral treatment medical and health personnel and the publicity and education of therapists to improve the effect of antiretroviral treatment in response to the factors affecting death and attrition.