{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T15:09:31Z","timestamp":1786115371760,"version":"build-2736575974"},"reference-count":14,"publisher":"SAGE Publications","issue":"6-7","license":[{"start":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T00:00:00Z","timestamp":1779926400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["AIDS Patient Care and STDs"],"published-print":{"date-parts":[[2026,7,1]]},"abstract":"<jats:p>Hepatitis C virus (HCV) is transmitted primarily through parenteral exposure to infected blood, and sexual transmission in heterosexual couples has generally been considered inefficient. However, this conclusion is based largely on studies of immunocompetent monogamous couples and may not fully apply to women living with human immunodeficiency virus (HIV). This narrative review integrates biological, virological, and epidemiological evidence relevant to sexual acquisition of HCV in women with HIV, with particular attention to heterosexual exposure, women without injection drug use, genital tract shedding, and partner-related cofactors. Baseline heterosexual transmission risk appears to be very low in low-risk couples, yet the epidemiological evidence in women is sparse, mostly observational, and often underpowered. Even so, converging biological and epidemiological signals suggest that this risk may be underestimated in selected settings. In women living with HIV, chronic cervicovaginal inflammation, sexually transmitted infections, HPV-related cervical abnormalities, genital bleeding, and impaired local immune defenses may create a mucosal environment more permissive to the acquisition of blood-borne viruses during sex. HCV RNA has also been detected in the female genital tract, particularly in the presence of blood. Current evidence does not demonstrate that HIV is a definitive causal risk factor for sexual HCV transmission in women, but it does support the view that HIV may act as a clinically relevant risk modifier in selected exposure settings, particularly when the male partner is coinfected with HIV and HCV and has injection-related risk. In the direct-acting antiviral era, this issue has practical implications for enhanced testing, partner management, and treatment of current HCV infection in discordant partnerships.<\/jats:p>","DOI":"10.1177\/10872914261455401","type":"journal-article","created":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T10:24:57Z","timestamp":1779963897000},"page":"227-230","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Sexual Acquisition of HCV in Women Living with HIV: Biological Plausibility, Epidemiological Signals, and Implications for Enhanced Testing and Treatment Strategies"],"prefix":"10.1177","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8513-6449","authenticated-orcid":false,"given":"Nicola","family":"Abrescia","sequence":"first","affiliation":[{"name":"AORN Dei Colli, Hospital for Infectious Diseases \u201cD., Cotugno,\u201d Naples, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adelaide","family":"Maddaloni","sequence":"additional","affiliation":[{"name":"AORN Dei Colli, Hospital for Infectious Diseases \u201cD., Cotugno,\u201d Naples, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriella","family":"Molinaro","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, School of Nephrology, University of Naples \u201cFederico II,\u201d Naples, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maurizio","family":"D\u2019Abbraccio","sequence":"additional","affiliation":[{"name":"AORN Dei Colli, Hospital for Infectious Diseases \u201cD., Cotugno,\u201d Naples, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,5,28]]},"reference":[{"key":"e_1_3_2_2_1","unstructured":"1.World Health Organization. Hepatitis C. Geneva: World Health Organization; 2025. Available from: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/hepatitis-c [Last accessed: March31 2026]."},{"key":"e_1_3_2_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.26164"},{"key":"e_1_3_2_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.2004.04150.x"},{"key":"e_1_3_2_5_1","first-page":"245","volume-title":"Proceedings of the XIV International AIDS Conference; 2002 Jul 7\u201312","author":"Abrescia N","year":"2002","unstructured":"4.Abrescia N, , Busto A, , D\u2019Abbraccio M, et al. HCV sexual transmission in HIV sexually infected women. In: Proceedings of the XIV International AIDS Conference; 2002 Jul 7\u201312; Barcelona, Spain. Bologna: Monduzzi Editore; 2002. pp. 245\u2013248."},{"key":"e_1_3_2_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.23808"},{"key":"e_1_3_2_7_1","unstructured":"6.Panel on Opportunistic Infections in Adults and Adolescents with HIV. Human papillomavirus disease. In: Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV [Internet]. Bethesda (MD): National Institutes of Health; 2024. Available from: https:\/\/clinicalinfo.hiv.gov [Last accessed: Mar31 2026]."},{"key":"e_1_3_2_8_1","doi-asserted-by":"publisher","DOI":"10.1086\/491742"},{"key":"e_1_3_2_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcv.2010.09.009"},{"key":"e_1_3_2_10_1","unstructured":"9.Panel on Antiretroviral Guidelines for Adults and Adolescents. Hepatitis C virus\/HIV coinfection. In: Guidelines for the use of antiretroviral agents in adults and adolescents with HIV [Internet]. Bethesda (MD): National Institutes of Health; 2023. Available from: https:\/\/clinicalinfo.hiv.gov [Last accessed: March31 2026]."},{"key":"e_1_3_2_11_1","doi-asserted-by":"publisher","DOI":"10.1089\/apc.2009.0111"},{"key":"e_1_3_2_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0000000000000834"},{"key":"e_1_3_2_13_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cis694"},{"key":"e_1_3_2_14_1","unstructured":"13.Centers for Disease Control and Prevention. Viral hepatitis\u2014HCV infection. Sexually transmitted infections treatment guidelines 2021. Atlanta (GA): CDC. 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