Abstract

Abstract Background National US data on the burden and risks for hepatitis C virus (HCV) infection in people with HIV (PWH) during the direct-acting antiviral (DAA) era are limited. These data are important to understand current progress and guide future efforts toward HCV microelimination. Methods We evaluated (1) HCV prevalence (2011-13, 2014-17, 2018-22) using a serial cross-sectional design and (2) correlates for HCV viremia (2018-22) in adult PWH within the CNICS cohort using multivariable adjusted relative risk regression. The most recent data from each time period were used for calculations and models. Results In the CNICS cohort, HCV viremia prevalence was 8.7% in 2011-13, 10.5% in 2014-17, and 4.8% in 2018-22. Disparities in prevalence across demographic groups defined by age, gender, and race/ethnicity were smaller in 2018-22 than earlier time periods. In relative risk regression, female gender, detectable HIV RNA, higher proportion of missed visits (last 18 months), higher FIB-4 score, higher depressive symptom severity, and current use of methamphetamine and illicit opioids were associated with HCV viremia in 2018-22. Conclusions The prevalence of HCV viremia during the DAA era in this US-based national cohort of PWH improved over time and across demographic subgroups but remains higher than those without HIV. Our findings highlight the continued importance of prioritizing HCV care in all PWH, especially in certain key, less reached groups. Proactive, comprehensive efforts to care engagement, substance use, mental health, and other social determinants will be crucial to improve reach, prevention, and treatment to achieve HCV elimination goals.