Introduction: Treatment adherence with antiretroviral therapy (ART) and its related factors have hitherto been the subject of clinical concern. However, research focusing on the relationships between ART adherence and the presence of psychological distress and selected personality traits have yet to be concluded. Therefore, our study aimed to remedy this. Methods: A multicentre hospital-based cross-sectional study was conducted in northwest Peninsular Malaysia on HIV outpatients given ART from July 1st, 2018, till April 31st, 2020. Participants were recruited via purposive sampling. Data were collected through an interviewer-guided questionnaires: Hospital Anxiety and Depression Scale (HADS) and Zuckerman-Kuhlman personality test (ZKPQ-M-40-CC), and interviewer-guided Timeline Follow-back (TLFB) for the assessment of adherence to ART. Results: A total of 229 patients completed the study. Majority (n=220, 96.1%) were considered adherent to ART. Among those who were non-adherent, two (22.2%) had anxiety disorder and five (55.6%) had depressive disorder. There was no significant association between treatment adherence and the presence of anxiety nor depression. However, sociodemographic factors determined that age group (p=0.033) and marital status (p=0.044) were significantly associated with treatment adherence. Multivariate analysis determined that ‘Active’ personality trait increases the likelihood to better treatment adherence by 1.14 times (95% CI: 1.02, 1.28, p=0.018). Conclusion: We did not find any association between treatment adherence and the presence of anxiety or depression. However, higher scores in ‘Active’ personality trait increases the likelihood of better treatment adherence among adult HIV on ART.