<p>Venezuelan immigrants living with HIV (VILH) in Miami represent a growing and understudied population that may face substantial barriers to continuous HIV care due to prior treatment disruptions, migration-related stressors, and limited healthcare access. This study compares HIV treatment trajectories, medication histories, and viral suppression among VILH, U.S.-born people living with HIV (PLWH), and other foreign-born PLWH in Miami. We used medical record abstractions from four HIV clinics in Miami. Eligible participants (<i>n</i> = 528) were newly enrolled between 2015 and 2019 and classified into three groups: VILH, U.S.-born PLWH, and other foreign-born PLWH. Generalized estimating equations (GEE) were used to assess longitudinal changes in viral suppression and antiretroviral therapy (ART) regimen changes across groups. VILH were more likely to have prior ART exposure (64%) compared to U.S.-born (37%) and other PLWH (33%). Viral suppression improved across all groups, with 89% of VILH achieving suppression at The last visit, compared to 86% among U.S.-born and other PLWH. ART regimen changes and drug resistance testing varied by group, with VILH experiencing more frequent regimen modifications and higher resistance positivity early in care. Significant interactions between migration status and time were observed for both viral suppression and regimen changes (<i>p</i> &lt; 0.001). VILH experienced treatment disruptions prior to migration, shown by higher prior ART use, more regimen changes, and increased resistance at care entry. Despite these challenges, VILH achieved comparable viral suppression with sustained care. Ensuring timely and consistent ART regimens for migrants is essential to support treatment continuity and reduce the risk of drug resistance.</p>