The southeastern US is a domestic epicenter for incident HIV with high prevalence of human papillomavirus (HPV) and herpes simplex virus (HSV) co-infections. However, epidemics of HPV and HSV-associated clinical conditions (CC) among people living with HIV-1 infection (PLWH) are not fully known. Methods Electronic medical records (EMR) of PLWH attending one of the leading HIV clinics in the southeastern US between 2006 and 2018 were reviewed and analyzed. The retrospective study was nested

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... n the University of Alabama at Birmingham HIV clinical cohort, which has electronically collected over 7000 PLWH's clinical and sociobehavioral data since 1999. Incidence rates of HPV-related CC including anogenital warts, penile, anal, cervical, and vaginal/vulvar low-and high-grade squamous intraepithelial lesions (LSIL and HSIL) and HSV-related CC including anogenital herpetic ulcers were estimated in per 10000 person years. Joinpoint regressions were performed to examine temporal changes in the trends of incident CC. All rates and trends were stratified by gender and race. Results Of the 4,484 PLWH eligible individuals (3,429 men, 1,031 women, and 24 transgender), we observed 1,038 and 425 patients with HPV-and HSV-related CC respectively, and 163 patients with both conditions. The mean log10 viral load (VL) was higher in all of the case groups than the non-cases with neither conditions (5.0) (whereas the median nadir CD4 counts (cells/uL) was higher in the non-cases than in any of the case groups (P<0.05). Anogenital warts, anal LSIL, HSIL, and cancer were more likely to be diagnosed among HIV-infected men than women. White men presented more frequently with anal LSIL and anal and penile cancers than black men (P<0.03). White women were also more likely to