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  • Coinfection with hepatitis C virus (HCV) can occur among some people with HIV
  • Researchers in six countries monitored 6,144 people with HIV who had recovered from HCV
  • Combined rates of reinfection and first-time infections fell between 2010 and 2019

Due to shared routes of transmission, some people with HIV are also co-infected with hepatitis C virus (HCV). Treatment for HCV consists of combination treatment in one pill called direct-acting antivirals (DAAs). This treatment is highly effective in most people with HCV, resulting in cure rates of 95% or greater. DAAs are generally well tolerated and safe.

Some clinics may be reluctant to treat people with HCV (whether or not they have HIV co-infection) because of concern that they may become re-infected due to ongoing risk factors.

To explore the issue of HCV reinfection, a team of researchers in six countries— Australia, Canada, France, the Netherlands, Spain and Switzerland—pooled their data from clinics that provided care for people with both HIV and HCV. They focused on 6,144 people with HIV who had recovered from HCV, either through treatment with DAAs (69%) or by spontaneously clearing HCV (31%). The study took place between January 2010 and December 2019.

Study details

The brief average profile of the 1,644 participants upon entering the study was as follows:

  • 49 years old
  • 81% male, 19% female
  • CD4+ count – 580 cells/mm3
  • suppressed HIV viral load – 81%
  • 46% were gay, bisexual or other men who have sex with men (gbMSM)
  • 38% were people who injected drugs
  • 5% were gbMSM who injected drugs

Researchers did not have information about the HCV risk factors for the remaining participants.

Key findings

Prior to the availability of DAAs (in about 2014), reinfection rates were relatively stable. Between 2015 and 2019, access to DAAs became broadly subsidized in the countries participating in this study. In that period, the combined rate of infection (a combination of rates of reinfection and first-time HCV infection) declined by 34%.

The researchers stated: “HCV reinfection incidence and combined incidence declined in people with HIV following DAA introduction, suggesting that reinfection has not affected [efforts to eliminate HCV] among people with HIV [in the countries studied].”

Monitoring and support

The researchers stated that their findings “highlight the importance of monitoring HCV [viral load] in people who have been cured or had spontaneous clearance of [HCV] infection to identify reinfections.”

They also stated that HCV “prevention programs with continued emphasis on harm reduction and risk reduction counselling for people who inject drugs and gbMSM" are needed at the point of HCV diagnosis and treatment.”

Bear in mind

Note that for this analysis the researchers only tracked data to December 2019. Shortly after that time the onset of the global COVID-19 pandemic occurred. The disruption caused by the pandemic likely affected people’s access to HCV testing, treatment and harm reduction services. Hopefully, future analyses of this study will shed light on the impact of COVID-19 and how countries are trying to overcome its effect on HCV testing and treatment programs.

Overall, the researchers found their results reassuring: Key populations, such as people who have HIV and HCV and who recover from HCV, are on track to have HCV eliminated by 2030, if the progress found in the study can be sustained. In the meantime, much work continues to be needed to ensure that all populations with HCV and people who have recovered from HCV have continued access to HCV testing and, when necessary, treatment, harm reduction and other services needed for healthy living.

—Sean R. Hosein


Hepatitis C testing and diagnosisCATIE

Blueprint to inform hepatitis C elimination efforts in CanadaCanadian Network on Hepatitis C

Harm Reduction Fundamentals: A toolkit for service providersCATIE

Elimination of hepatitis by 2030World Health Organization

Canadian Liver Foundation


Sacks-Davis R, van Santen DK, Boyd A, Changes in incidence of hepatitis C virus reinfection and access to direct-acting antiviral therapies in people with HIV from six countries, 2010-19: an analysis of data from a consortium of prospective cohort studies. Lancet HIV. 2024 Jan 12:S2352-3018(23)00267-9.