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Among 361 PWID with ≥1 viral load after six months on ART, proportions with VS were 82%, 88% and 93% at 2-, 5- and 10-years following ART initiation. There were 52 new AIDS-defining events and 50 deaths during 3347 person-years of follow-up (PYS) (incidence 3.05/100 PYS, 95% CI, 2.51 to 3.7. Previous AIDS or TB diagnosis, lower current CD4 count and adherence 95% were associated with combined new AIDS-defining event and death. Despite improved outcomes over time, our findings highlight the need for rapid ART initiation and adhere