Summary Background People with HIV-1 (PWH) age differently than the general population. Blood telomere length (BTL) attrition is a surrogate biomarker of immunosenescence and ageing in PWH. BTL is reduced immediately after HIV-1 infection, and recovers in long-term virologically suppressed PWH, but the extent of this recovery is unknown. Methods Prospective 6-year observational study assessing the evolution of BTL in virologically suppressed PWH, and a cross-sectional analysis comparing BTL with age and sex-matched blood donors, and sex matched persons older than 60 from a general population cohort. DNA from whole blood was isolated and relative BTL was determined by monochrome quantitative multiplex PCR assay and expressed as the ratio of telomere to single-copy gene (T/S). Results A total of 128 PWH were included in the prospective 6-year observational study. These same 128 PWH (median age 55 years, 27.3% women) were compared cross-sectionally at the 6-year follow-up to 128 age- and gender-matched blood donors (median age 55 years) and to 128 gender-matched individuals older than 60 from a general population cohort (median age 70 years). An inverse correlation between age and BTL was observed. PWH had shorter BTL than their matched blood donor (T/S 1·07 [IQR 0·95-1·17] vs.1·28 [IQR 1·12-1·48], p<0·001), but longer than the elderly population (0·89 [IQR 0·77-0·98], p<0·001). PWH experienced a BTL increase at 6-years of 2·9% (T/S 1·04 vs. 1·07, p=0·002). In PWH, age was associated with shorter BTL -0·00745 (SE=0·00204, p=0·002) and baseline lower CD4 count with a gain in BTL -0·00006 (SE=0·00002, p=0·004). Shorter baseline BTL (OR 0·91 [95%CI 0·87–0·94], p<0·001), and higher glucose levels (OR 1·04 [95%CI 1·02–1·07], p=0·003) were associated with a greater similarity of BTL to the elderly population. Conclusion PWH with long-term virological suppression experience a trend toward increased BTL after 6 years of follow-up. Middle-aged long-term controlled PWH have shorter BTL than expected for their chronological age, but longer than those of people 15 years older in the general population.