Data support the impact of antiretroviral therapy (ART) on the burden of cervical HPV and related lesions. ART is effective at reducing the prevalence and incidence of high-risk (HR)-HPV infection but only over longer duration, and among patients with effective ART (i.e. with high adherence, HIV viral suppression and increasing CD4+ T lymphocyte counts). ART has a protective effect against squamous intraepithelial lesion (SIL) incidence and progression and induces regression with the greatest likelihood among adherent users. ART initiated at high CD4+ is effective at preventing HR-HPV infection and SIL progression. If ART is started at a low nadir CD4+, women have increased risk of SIL progression and screening will be important at frequent intervals.