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The morbidity and mortality caused by HIV/AIDS have significantly decreased as a result of the introduction of highly active antiretroviral treatment (HAART). The frequent occurrences of HAART adverse drug reactions (ADRs) potentially negate the recent advances made in the treatment of the infection. The aim of this present study is to assess the frequency, severity, and connection between ADRs and the HAART regimens being utilized by HIV/AIDS patients in an Ilorin teaching hospital. Using a validated data capture form created for the study, we retrospectively evaluated and analyzed the clinical records of patients living with HIV/AIDS who received treatment at the Antiretroviral Therapy Clinic in UITH between January 2022 and December 2022. The severity of the ADRs was evaluated using a modified Hartwig and Siegel scale, and causality was evaluated using Naranjo's likelihood scale. The evaluation included 384 patient case files that met the inclusion criteria. The most prevalent adverse medication reactions were seen in young adults between the ages of 31 and 40, and they were more common in females (65.9%) than in males (34.1%). Patients with the most often prescribed first-line combination of Tenofovir, Lamivudine, and Dolutegravir experienced the highest frequency of ADRs. The most frequent ADRs were nausea and vomiting (39.6%), followed by loss of appetite (29.4%), and exhaustion (15.9%). The majority of ADRs (92.7%) were mild in nature, and 80.5% were likely caused by the HAART combination that was being used, according to the assessment of severity. Loss of appetite, nausea, and vomiting were the most frequent ADRs. They were frequently observed in female patients receiving the tenofovir, lamivudine, and dolutegravir first-line combination. The majority of ADRs were low in severity and most likely resulted from the usage of the HAART combination. ADRs should be actively monitored, patients should be taught to promptly report ADRs, and HAART combinations with a history of proven safety and efficacy should be used in order to build on the successes of HAART in the treatment of HIV/AIDS.