PURPOSE The distribution of high-risk human papillomavirus (hrHPV) genotypes in women living with HIV (WLWH) and cervical neoplastic lesion (CNL) are not clearly predictable. We sought to determine prevalence of hrHPV genotypes, distribution, risk of multiple hrHPV and CNL in WLWH in Jos, Nigeria. METHODS Study was carried out from a cohort of study participants in the u54 NIH/NCI funded project titled ‘Epigenomic biomarkers of HIV-Associated Cancers in Nigeria’ (U54CA221205) in Jos, Nigeria. WLWH who were CC-free (n=22), precancer (61) and CC (n=17) gave informed consent and participated in the study between Oct’-2019 & Sept’- 2022. Information on socio-demographic and clinical history were obtained using structured questionnaire. Cervical-vaginal specimens collected, HPV DNA detection and genotyping performed using Anyplex-II HPV28 kit (Seegene, Korea). Prevalence and distributions of hrHPV genotypes determined and logistic regression analysis used to analyze associations between multiple hrHPV and CNL. RESULTS Of the 101 WLWH, median age was 50.00 (IQR 43-57), median duration of HIV infection was 12 years (IQR 9-14), and median age at sexual debut was 18 years (IQR 16-20). History of multiple sexual partners (MSP) was 70.3%. The overall hrHPV prevalence was 57.4%, with single hrHPV in 29.7% and multiple hrHPV in 27.7%. The three commonest hrHPV genotypes were HPV 16 (12.9%), HPV 31 (10.9%), and HPV 45/52/58 (9.9%). HPV genotypes 16/18/other-hrHPVs was 10.9%, and HPV 31/33/45/52/58 without HPV 16 or 18 was 11.9%. HPV 16 was higher for precancer, and CC compared with CC-free (46.1% vs 38.5% vs 15.4%, p=0.113) and HPV 31/other-hrHPVs was higher in precancer and CC (71.4% vs 28.6% vs 0%, p=0.282) and other-hrHPVs without genotype 16 or 18 was higher in precancer compared with CC-free and CC (82.3% vs 5.9% vs 11.8%, p=0.141). History of MSP (aOR=8.18, 95% CI 1.44, 59.04), age at first cervical cancer screening (aOR=7.5, 95% CI 1.29, 63.23), and duration of HIV infection in years (aOR=0.86, 95% CI 0.73, 0.99), were independently associated with multiple hrHPV genotypes. CONCLUSION There is high prevalence of multiple hrHPV genotypes with diverse distribution. Universal HPV vaccination and HPV DNA testing for cervical cancer screening in HIV clinics may lead to reduction in incidence of CNL among the most at risk population.