Introduction: Tuberculosis is the leading cause of death for HIV-infected patients, and HIV is the most important risk factor for developing active TB. The risk of death from TB is significantly higher in the HIV-infected population. The interaction between TB - HIV co-infected person is bidirectional and synergistic: HIV-1 infection predisposes to the development of active TB, and the course of HIV-related immunodeficiency is worsened by active TB infection. Objective: The aim of this study was to assess the level of TB - HIV co-infection at Fenote Selam district Hospital, Amhara, Northwest Ethiopia, 2014. Methods and materials: Fenote Selam district hospital is 378 km from capital city of Ethiopia, Addis Ababa. The study was conducted in May 2014. To determine the level of TB-HIV co-infection, retrospective data review method was used. Medical records of all TB patients who were on anti tuberculosis treatment from March, 2009 to March, 2014 were included in the study. The patients’ records in the five years were 651. Data were collect from patients’ medical record. Ethical approval and clearance was obtained from Debre Markos University Medicine and Health Science College of Ethical Review Committee (ERC).