BACKGROUND: Collating evidence on the impact of highly active antiretroviral therapy (HAART) on the outcome of cervical lesions or human papillomavirus (HPV) infection among women living with HIV (WLHIV) is essential to inform cervical cancer prevention in this vulnerable group. METHODS: We performed a systematic review and meta-analysis of cohort studies that were conducted between January 1, 1996 and January 31, 2022 and reported on the association of HAART with any of the outcomes: incidence, progression, or regression of cervical lesions or acquisition or clearance of HPV infection in WLHIV. Random-effect analysis was used for summary statistics and heterogeneity was assessed through I statistic. The protocol for this review has been registered on the PROSPERO database with registration number CRD42021285403. RESULTS: Among 11 studies, the summary estimate of incident cervical lesions was lower in WLHIV on HAART (0.81, 95% CI 0.60-1.08). HAART was associated with lower risk of cervical lesion progression (0.76, 95% CI 0.64-0.92, I 55.6%) and higher regression rate of these lesions (1.43, 95% CI 1.06-1.94, I 81%). Though HPV acquisition was not significantly lower in HAART users (0.83, 95% CI 0.40-1.70), the clearance of HPV infection was higher in WLHIV on HAART (1.41, 95% CI 1.14-1.76, I 2.4%). CONCLUSION: This review provides evidence that HAART assists in reducing the incidence and progression of cervical lesions and enhancing their regression in women living with HIV. Hence, the HAART regime should be recommended to all WLHIV with advice for adherence to allow for early immune reconstitution.