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Mortality fell from 121 to 16 per 1000 person-years from 1994 to 2017 (P less then .001). In 2010, 83.7% of HOPS participants had a most recent HIV viral load less then 200 copies/mL, compared with 92.2% in 2017. Conclusions Since 1993, the HOPS has been detecting emerging issues and challenges in HIV disease management. HOPS data can also be used for monitoring trends in infectious and chronic diseases, immunologic and viral suppression status, retention in care, and survival, thereby informing progress toward the Ending the HIV Epidem