There is no derivable data in literature regarding the ultrasonographic findings in HIV assoiated renal damage and its correlation with serum creatinine level and CD4 counts in North East Indian population. The impact of antiretroviral therapy (ART) on the progression of renal disease is not substantiated. This necessitated the conduct of this study. AIMS AND OBJECTIVE: To establish a consociation between renal ultrasound findings and serum creatinine levels, CD4 cell counts in adult patients with HIV associated renal damage; and to study the effects of anti–retroviral therapy on these findings. MATERIALS AND METHODS: A total of 102 serologically proven HIV positive patients with increased serum creatinine were subjected to renal ultrasonography. Two study groups were formed including n₁= 50 HIV positive on anti–retroviral therapy (HOART) and n₂= 52 HIV not on ART (HNOART). This data was correlated with the serum creatinine and CD 4 counts. STATISTICAL ANALYSIS: The data obtained were recorded on Data sheet and analyzed using SPSS for windows version 16. RESULTS: The patients aged between 20 and 52 years. Of the 102 cases studied (i.e. 204 kidneys), ultrasound showed abnormal echogenicity in 200 kidneys (98%). Renal dysfunction was found to be commoner in patients not on antiretroviral medication (37.8%) than patients on antiretroviral medications (27.3%). Majority of patients on ART had lower grades of renal echotexture. The lower the CD4 count, the higher the degree of the renal echogenicity. Although, the higher the serum creatinine levels, the higher the degree of the renal echogenicity. CONCLUSION: The degree of the renal echogenicity was found to be inversely proportional to the CD4 cell counts, but showed positive linear correlation with increasing serum creatinine level. Prognosis worsens with higher serum creatinine and lower CD4 cell counts. The anti–retroviral medications help retard the progression of renal damage.