Human immunodeficiency virus (HIV) has become a worldwide pandemic with over seventy percent of those infected in the sub Saharan Africa, and women are disproportionately affected. Cervical cancer is one of the leading causes of death in the world and in Nigeria. The pre-malignant stage, cervical intraepithelial neoplasia is diagnosed using Papanicolaou test. It has been found that HIV positive women have a higher rate of cervical intraepithelial lesion and cervical abnormalities. The study was carried out to determine the prevalence of cervical abnormalities in HIV positive women, in Lagos, Nigeria. Five hundred and ninety two women were tested comprising 292 HIV positive women as test and 300 HIV negative women as control. The subjects were from the HIV clinic in LUTH and the controls were recruited among patients undergoing routine Pap smear patients in LUTH and St.Kizito’s Clinic, a missionary hospital, Lekki. The study found that there is a higher prevalence of cervical dysplasia among the HIV positive women compared with their HIV negative counterpart (20.2% vs 9.4%); also there is higher rate of Human papillomavirus cytopathic effect among the HIV positive women (6.8% vs 3.7%) It was also observed that there is a decrease in abnormal smear pattern with high CD4 count and with the use of highly active antiretroviral therapy (HAART). The average CD4 count in this study showed that many of them were well managed by the highly active antiretroviral treatment. There is however no significant relationship between cytologic pattern and early menarche, educational status, age of the patients and the duration from time of diagnosis. It is hereby recommended that there should be a National policy for routine Pap smear as well as incorporating regular Pap smear into the management of HIV positive women. The government is also encouraged to continue voluntary HIV testing so that the affected could be picked early before immunosupression sets in.