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Interferon(IFN)-based hepatitis C virus (HCV) therapy has been replaced by direct-acting antivirals (DAAs). We assessed temporal trends in patient characteristics, transmission risks, treatment initiation, and cure rates in eras of IFN, restricted DAA-access, and unrestricted DAA-access in Viennese HCV/HIV-coinfected patients (HIV/HCV). Consecutive HIV/HCV-coinfected patients starting HCV treatment at the Vienna General Hospital between 2002 and 2020 were retrospectively enrolled. Of all  N  = 508 HIV/HCV, 78% (398/508) were male and the mean age was 41.8 ± 9.5 years. ‘People-who-inject-drugs’ (PWID) accounted for 61% (311/508), while 31% (156/508) were ‘men who have sex with men’ (MSM). In the IFN-era, restricted DAA-era and unrestricted DAA-era,  N  = 152,  N  = 129, and  N  = 227 HCV treatments were started and 49% (74/152), 95% (122/129), and 88% (200/227) achieved sustained virologic response, respectively. Treatment during the IFN-era was a strong predictor for virologic non-response (aOR 12.69; 6.93–23.24) and loss-to-follow-up (aOR 6.12; 2.99–12.54), while virologic non-response was less common in ‘MSM’ (aOR 0.28; 0.13–0.62). Ninety three percent (50/54) of the observed HCV reinfections occurred in the unrestricted DAA-era. A substantial increase in ‘MSM’ transmission was observed since 2010 with 66% (107/161) in the DAA-era versus 15% (49/330) prior to the DAA-era. HCV cure rates in Viennese HIV patients increased from 49% in the IFN-era to 88–95% in the DAA-era. MSM-related risk behaviour and reinfections became the key challenges towards HCV elimination in HIV-coinfected patients.

Progress of Hepatitis C elimination in Viennese people living with HIV after two decades of increasing cure rates