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Objective This study aims to investigate the mortality among HIV/AIDS patients receiving antiretroviral therapy (ART) in Fangchenggang City, Guangxi Province, and to identify associated factors with AIDS-related and non-AIDS-related deaths, providing scientific evidence for reducing AIDS mortality. Methods We collected data from the National Comprehensive AIDS Prevention and Control Information System. These data included socio-demographic and follow-up records of 2 728 HIV-1 infected individuals receiving Antiretroviral Therapy (ART) treatment in Fangchenggang City from January 1, 2005 to July 5, 2022. This dataset included socio-demographic and follow-up records during the specified period, providing a comprehensive insight into the therapeutic responses, survival rates, and potential associated complications among ART-treated HIV/AIDS patients within Fangchenggang City. Socio-demographic and follow-up data were analyzed using the cumulative incidence function (CIF) under a competing risk framework and the Fine-Gray subdistribution hazard regression model to assess the associated factors with both AIDS-related and non-AIDS-related deaths. Results With an average follow-up period of 6.7 person-years, 295 cases experienced AIDS-related death with a mortality rate of 1.06/100 person-years, while 227 cases died from non-AIDS-related causes, with a mortality rate of 1.2/100 person-years. Under consideration of competing risks, the cumulative incidence of AIDS-related death at 1 year, 5 years, and 13 years post-diagnosis was 2.5%, 8.5%, and 15.0%, respectively. The factors associated with a higher risk of AIDS-related death included: age 60 years or older (aHR = 1.5, 95% CI: 1.05~2.15), current spouse's infection status unknown/not investigated (aHR = 1.39, 95 % CI: 1.03~1.90), history of prophylactic treatment for opportunistic infections (aHR = 1.4, 95% CI: 1.06~1.84), and occurrence of opportunistic infections or tumors (aHR = 1.65, 95% CI: 1.12~2.45) . On the contrary, factors associated with a lower risk of AIDS-related death included: being female (aHR = 0.61, 95% CI: 0.49~0.90), initial treatment regimen containing EFV (aHR = 0.41, 95% CI: 0.25~0.68), having changed the treatment regimen (aHR = 0.19, 95% CI: 0.12~0.29), first CD4 cell count ≥ 200 cells/µL (aHR = 0.30, 95% CI: 0.20~0.45), initial viral load (VL) between 50 to 1000 copies/ml (aHR = 0.31, 95% CI: 0.18-0.54), and VL < 50 copies/ml (aHR = 0.61, 95% CI: 0.44~0.84). Regarding non-AIDS related deaths, passive detection (aHR = 1.41, 95% CI: 1.0~1.98), uninvestigated/unknown spouse's infection status (aHR = 1.40, 95% CI: 1.01~1.95), and first CD4 cell count ≥200 cells/ (JLL (aHR = 1.68, 95% CI: 1.27~2.22) were found to be associated with increased risk. In contrast, lower risk factors included being female (aHR = 0.55, 95 % CI: 0.37-0.81), having experienced a change in antiviral treatment regimen post-initiation (aHR = 0.33, 95%CI :0.21-0.50), initial treatment regimens containing EFV (aHR = 0.55, 95% CI: 0.34-0.88), and NVP (aHR = 0.50, 95% CI: 0.3-0.83). Conclusion The mortality rate among HIV/AIDS patients receiving ART in Fangchenggang City is relatively low. This study underscores the importance of preventing and treating opportunistic infections or tumors for improving the survival of HIV/AIDS patients. HIV/AIDS care clinics should particularly focus on monitoring and following up on female patients, older patients, and those detected passively, enhancing medication adherence, expanding HIV testing among key populations, and thereby striving to reduce the mortality rate among AIDS patients. [ABSTRACT FROM AUTHOR]