People living with both HIV and hepatitis C virus (HCV) can benefit from direct-acting antiviral (DAA) therapy, but many are not receiving treatment. This is a concern because people with HIV/HCV coinfection are more likely to experience severe liver disease than those with HCV alone. Researchers looked at disparities in DAA uptake among people with HIV in the United States and Canada. Among 6,300 treatment-eligible people with HIV/HCV coinfection, 58% initiated DAAs between 2014 and 2021. While the treatment gap narrowed over time, some groups are still falling through the cracks. Heterosexuals and people who inject drugs were less likely to start DAA treatment than gay or bisexual men. Black and Latino people also had lower rates of DAA initiation, as did those who reported heavy alcohol use, smoking, a detectable HIV viral load or a prior AIDS diagnosis. Conversely, those with worse liver fibrosis were more likely to start DAAs. The researchers highlighted the need to develop targeted approaches to increase equity in DAA initiation by addressing disparities to eliminate HCV among people with HIV.