Abstract: Introduction and objectives: HCV has been a significant health issue among people with HIV (PWH) in Spain. Several factors have in fluenced the epidemiology of HIV/HCV coinfection, including the introduction of all-oral DAA therapies in 2015. This study assesses HCV prevalence among PWH in Spain in 2023 and compares findings with eight similar studies since 2002. Methods: All studies aimed to determine the prevalence of anti-HCV antibodies and active HCV (HCV-RNA+). The reference population was PWH with at least one healthcare encounter in the past year. Sample size accuracy ranged from 3% in 2002 to below 1% in recent years. Ran dom sampling with proportional allocation was used in all studies. Results: The fig. summarizes study metrics and patient characteris tics. HCV seroprevalence fell from 60.8% in 2002 to 27.4% in 2023, and active HCV declined from 54.0% in 2002 to 0.9% since 2021 (Fig.). Cirrhosis in patients with active HCV peaked at 23.1% in 2015 and dropped to 0% in 2021-2023 but was 20.4% in 2023 among those who cleared HCV with treatment. Conclusions: Over the past two decades, active HCV among PWH in Spain dramatically decreased, now representing a marginal issue within this population. However, the burden of cirrhosis remains significant among those successfully treated. The introduction of DAAs has been pivotal in reducing active HCV infection prevalence to below 1% since 202

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