As the US moves increasingly towards using human papillomavirus (HPV) testing with or without concurrent cytology for cervical cancer screening, it is unknown what the corresponding risks are following a screening result for women living with HIV (WLWH), which will dictate the optimal clinical follow-up. Therefore, using medical records data from Kaiser Permanente Northern California, which introduced triennial HPV and cytology co-testing in women aged 30–64 years in 2003, we compared risks of cervical intraepithelial neoplasia grade 2 (CIN2) or more severe diagnoses (CIN2+) in women not known to have HIV (HIV[−] women) (n = 67,488) frequency matched 111:1 on age and year of the first co-test to the 608 WLWH (n = 608). WLWH were more likely to test HPV positive (20.2% vs. 6.5%, p < 0.001) and have non-normal cytology (14.1% vs. 4.1%, p < 0.001) than HIV[−] women. Five-year CIN2+ risks for all WLWH and HIV[−] women were 3.5% (95%CI = 2.0–5.0%) and 1.6% (95%CI = 1.5–1.8%) (p = 0.01), respectively. Five-year CIN2+ risks for WLWH with positive HPV and non-normal cytology, positive HPV and normal cytology, negative HPV and non-normal cytology, and negative HPV and normal cytology were 24.9% (95%CI = 13.4–36.4%), 3.0% (95%CI = 0.0–7.4%), 3.6 (95%CI = 0.0–9.8%) and 0.3% (95%CI = 0.0–0.8%), respectively. Corresponding 5-year CIN2+ risks for HIV[−] women were 26.6% (95%CI = 24.6–28.7%), 8.5% (95%CI = 7.2–9.9%), 1.9% (95%CI = 1.0–2.8%), and 0.5% (95%CI = 0.4–0.6%), respectively. Thus, in this healthcare setting, the main cause in overall CIN2+ risk differences between WLWH and HIV[−] women was the former was more likely to screen positive and once the screening result is known, it may be reasonable to manage both populations similarly.