Low HCV seroprevalence among PLWH: a large cross-sectional study of 6722 individuals

Hepatitis C virus (HCV) coinfection is a significant comorbidity and public health concern among people living with HIV (PLWH). This study aims to estimate HCV seroprevalence among PLWH in Istanbul, Türkiye, and compare it with the HIV-negative control group and assess age-related patterns in PLWH.

We performed a multicentre cross-sectional study including patients from nine distinct hospitals representing diverse districts of Istanbul between January 2022 and October 2025. Data were retrieved from the central laboratory system serving this hospital network. Anti-HCV was tested by third-generation electrochemiluminescence immunoassay (Elecsys Anti-HCV II, Roche). A total of 3361 PLWH and 3361 age-comparable and sex-comparable HIV-negative controls were included. Between-group differences were assessed with Fisher's exact test; within PLWH, age-group differences and trends were evaluated with χ² and linear-by-linear association tests.

HCV seroprevalence was 0.71% among PLWH (24/3361) and 0.39% in the control group (13/3361), with no significant between-group difference (p=0.098). When PLWH were compared with HIV-negative controls, the odds of HCV seropositivity were not significantly increased (OR 1.85; 95% CI 0.94 to 3.70). Among PLWH, HCV seropositivity differed by age group (p=0.007) and increased with age (p<0.001), with no seropositive cases in individuals younger than 30 years and the highest prevalence in those older than 70 years. Genotyping was available for eight PLWH; genotype 3 predominated (5/8, 62.5%), followed by genotype 1 (3/8, 37.5%; including subtypes 1a and 1b).

HCV seroprevalence was low among PLWH in Türkiye and did not differ significantly from age-comparable and sex-comparable HIV-negative controls. The strong age gradient indicates that infections are concentrated in older cohorts and supports age-based screening for public health purposes in low-endemic settings.