Introduction:
Women living with human immunodeficiency virus (HIV) are at an increased risk for development of persistent human papillomavirus (HPV) infection, and expansion of precancerous lesions and invasive carcinoma of cervix. There is paucity of data from developing countries regarding HIV infection and its correlation with CD4+ counts.

Material and methods:
A hospital-based, observational, prospective cohort study was conducted at the antiretroviral therapy (ART) center of tertiary referral institute in South India. The aim of the study was to analyze the cytological abnormalities in women living with HIV, and compare the differences between patients on and not on ART. A detailed history and complete general and systemic examination were performed, followed by Pap smear.

Results:
The study included 228 women living with HIV, aged over 18 years, attending ART center OPD; 114 patients were on first-line ART for at least one year duration, and 114 were not on ART. In both the on ART and not on ART groups, the most commonly reported abnormal cytology report was inflammatory smear (36% and 25.4%) and bacterial vaginosis (9.6% and 10.5%), followed by low-grade squamous intra-epithelial lesion (16.7% and 14.9%). In high-grade squamous intra-epithelial lesion patients (n = 8), CD4+ counts were not found significantly different between those on and not on ART (p = 0.25).

Conclusions:
The current study reflects the absence of differences between cytological abnormalities in women on ART and not on ART as well as the lack of protective effect with the former on squamous intra-epithelial lesion.