Objective: To assess the prevalence of Tenofovir induced oral hyperpigmentation among HIV-infected patients in Kodagu Karnataka. Methods:168 HIV infected individuals who were receiving Tenofovir were included in the study. Proper muco-cutaneous examination was done. Site, duration from when the pigmented lesions started to appear and duration from when treatment was started were taken into consideration. All the collected data were recorded and statistically analyzed. Results:A total of 168HIV infected patients on anti-retro viral therapy Tenofovir, Lamivudine and Efavirenz regimen were included in the study. Oral mucosal pigmentation was seen in 52 (31%) subjects and 6 (3.6%) subjects had both intra oral and extra oral pigmentation i.e. pigmentation of skin, nail and oral cavity.Majority of the study population 85 (50.8%) were on Tenofovir for more than 5 years. Conclusion:Oral hyperpigmentation is one of the major side effect with prolonged treatment of Tenofovir. On prior explanation regarding adverse reactions adherence to the antiviral drug regimen can be improved.