Introduction: WHO has recommended global action to eliminate cervical cancer by the 21st century. HIV-infected women are at increased risk of acquiring HPV infection, progressing to pre-invasive, and invasive cervical cancers. Objectives: The objective was to assess the frequency of and the risk factors for pap smears abnormalities in HIV-seropositive and HIV-seronegative women. Materials and methods: This retrospective case control study conducted in a Medical College Hospital from January 2016 to December 2019 included case records of 330 married women aged more than 19 years. About 270 participants were eligible for controls and 60 for cases. Demographic details, CD4 count, and pap smear findings were noted, and statistical analysis was carried out. Results: Pap smear abnormalities were noted in 13.3% of HIV-infected women and 1.85% of HIV-negative women. The preponderance of inflammatory smear was 61.7% among seropositive women and 47% among seronegative women. The mean CD4 count among HIV-positive women was 534.34 ± 242.24 and in 64.14%, the CD4 count was >400. No statistically significant association between the abnormal pap smear results and the age of the individual, parity, and age at first intercourse was noted. Conclusion: Abnormal cervical cytology was seven times higher in HIV-infected women when compared with HIV-negative women and immunosuppression may be the predominant risk factor leading to cytological abnormalities in HIV-infected women. HIV-positive women showing inflammatory smears need further evaluation.