Genberg BL, Kirk GD, Astemborski J, et al. - In view of the knowledge that HIV treatment outcomes differ between people who inject drugs (PWID) and there may be less chance of these individuals attaining durable viral suppression, researchers analyzed a long-standing community-based cohort including PWID (AIDS Linked to the IntraVenous Experience (ALIVE)) among HIV+ participants with a study visit in or after 1997, to characterize transitions in and out of viral suppression from 1997-2017. The study sample comprised 1,061 people with median age 44 years and 32% and 93% being female and African-American, respectively. Those who had recently injected drugs were 59%, and those virologically suppressed at baseline were 28% in total. Over time, durable viral suppression improved significantly, however, death rates continued to be relatively stable. Increased virological rebound in earlier time periods was noted in relation to injection drug use and homelessness, while virological rebound in 2012-2017 was seen in relation to only age and race, as revealed in the adjusted analysis. An increased risk of death after suppression in 2012-2017 was observed in relation to opioid use. Overall, findings are suggestive of the possible requirement of additional efforts directed at sub-groups of PWID to maintain viral suppression and prevent premature mortality despite significant improvements observed in durable viral suppression.