Hepatitis C elimination in people with HIV: progress, gaps, and future directions

Direct-acting antivirals (DAAs) have transformed hepatitis C virus (HCV) management. People with HIV (PWH) are prioritized in elimination strategies due to higher HCV prevalence, faster progression, and linkage to HIV care. This review summarizes evidence on HCV elimination in PWH, highlighting progress, gaps, and future directions toward WHO elimination targets.

DAAs achieve cure rates above 95% in PWH across stages and contexts, with pangenotypic regimens enabling integration into HIV services. Studies in high-income countries report steep declines in HCV viremia among PWH, some nearing microelimination. Yet gaps persist as subsets remain untreated, with lower uptake among women, heterosexual men, migrants, and people who inject drugs (PWID). Reinfections cluster among MSM and PWID, though overall incidence has declined with treatment-as-prevention. In contrast, low-income and middle-income countries face restricted access, high costs, limited harm reduction, stigma, and criminalization, leaving interim 2025 goals unmet. Integrated HIV-HCV-substance use care, point-of-care diagnostics, telehealth, and community outreach improve linkage and treatment completion.

HCV elimination among PWH is feasible in well resourced settings, but global progress remains uneven. Universal screening, unrestricted DAA access, harm reduction, and sustained political commitment are essential to consolidate gains and prevent setbacks.