Ma J, et al. - Given the guidelines advocating universal, prompt treatment of hepatitis C (HCV) infection in HIV/HCV co-infected patients, researchers sought for the barriers to uptake of HCV direct-acting antivirals (DAAs) in this population. At an urban infectious disease clinic in Saint Louis, Missouri, the care cascade from HCV diagnosis to sustained virologic response (SVR) was retrospectively examined during the first 18 months of interferon-free DAA availability in the United States. They identified 1949 HIV patients that were seen in the clinic; screening for HCV was performed in 91.9% of these and chronic HCV infection with follow-up was reported in 5.4% (n = 106) of these. No insurance, substance abuse, poor HIV control, and younger age were noted to be correlated with delayed DAA treatment. Substance abuse, psychiatric disease, and uncontrolled HIV were most commonly correlated with providers delayed DAA treatment. In co-infected patients, a high success rate is observed with DAAs in this early period but limit uptake was noted in correlation to insurance delays and misconceptions from the interferon era.