Background Strategic plans have been developed to eradicate HCV worldwide.

Understanding patient factors associated with being untreated for HCV would help in supporting extra efforts in those patients to achieve HCV elimination in the coming years.

Purpose We evaluated the implementation of our country’s strategy in HIV/HCV coinfected patients and barriers to lower treatment implementation in this population.

Material and methods The HERACLES cohort is a multicentre, prospective observational cohort initiated in April 2015, which includes HIV-infected patients with active chronic HCV coinfection in follow-up at 19 centres for the care of HIV-infected patients from 1 May 2015 to 1 May 2017 (accession number: NCT02511496).

The main study outcome was receipt of HCV DAAs treatment from 1 May 2015 to 1 May 2017.

Variables identified as factors associated with lower treatment rate implementation were included in a logistic regression model for HCV treatment uptake.

Results Of the 15,556 HIV patients in care, 3075 (19.7%) presented with active chronic HCV infection and constituted the study population. By the end of the follow-up, 1957 patients initiated HCV therapy (63.6%).

In the multivariate analysis, an age lower than 50 years (OR (95% CI)=1,379 (1,109 to 1,713)), absence of or minimal liver fibrosis (F3: OR (95% CI)=9,866 (7,496 to 12,985); F4: OR (95% CI)=14.865 (10,786 to 12,985)), treatment-naïve patients (DAAs+Peg-IFN/RBV: OR: 95% CI=6.493: (3.081 to 10.878)), HCV genotype 3 infection (OR (95% CI)=0.689 (0.523–0.908)), people who injected drugs using opioid substitutive therapy (OST-PWIDs: OR: 95% CI=0.738: (0.588–0.927)), and recent PWIDs were identified as significant independent risk factors associated with low DAA implementation (OR: 95% CI=0.22 (0.005 to 0.092)).

Conclusion In the study period, a high number of HIV/HCV coinfected patients from our cohort received DAA therapy.

We identified factors, which did not include prioritisation of DAAs uptake strategy, that limited the access to HCV therapy. The low treatment uptake in several populations seriously jeopardises the completion of the HCV elimination in the coming years.

References and/or acknowledgements No conflict of interest.