All people with HIV should be screened for HCV, and all people found to have concurrent HCV should be prioritised for treatment of HCV and be managed by a multidisciplinary team with experience in managing both conditions.

HIV-HCV is associated with a reduced HCV clearance rate⁸ and a higher rate of cirrhosis compared with people with HCV alone. After 10 years, the prevalence of cirrhosis in people with HIV-HCV was 14.9%, compared to only 2.6% in those with isolated HCV, in one study⁹. While after 15 years, the prevalence of cirrhosis was 25% in people with HIV-HCV, compared to only 6.5% in those with isolated HCV¹⁰.

The impact of concurrent HIV-HCV is also observed in other population groups. HIV accelerates the progression of liver disease in people with haemophilia, and HCC occurs at a younger age and sooner in the time course in people with HIV-HCV²¹. Progression of HIV-related immunodeficiency is also associated with HCV liver disease progression, with lower CD4 T-lymphocyte (CD4) cell counts found to correlate with hepatic fibrosis and liver failure^11,12. People with HIV-HCV and mild fibrosis on liver biopsy may experience significant progression of hepatic fibrosis over only a 3-year period¹³. However, studies of the influence of HCV on the progression of HIV have been contradictory, with some studies suggesting an increase in HIV disease progression in people with concurrent HIV-HCV, while others demonstrated no influence on disease progression¹⁴.

Selection of DAA treatment of HCV in people with concurrent HIV-HCV is the same as the recommendations for people with isolated HCV. The only important consideration is choosing a DAA therapy regimen that minimises the potential drug-drug interaction and liver toxicity with current HIV antiretroviral therapy (ART) available. Careful evaluation of all relevant medications prior to commencement of DAA treatment is recommended. Management of HCV, treatment selection, and evaluating for potential drug-drug interactions will be discussed later in this chapter.