Recent advances in Hepatitis C Virus (HCV) treatment represent a paradigm shift for the treatment of HCV-infected persons with Human Immunodeficiency Virus (HIV) coinfection. With potent antiviral activity, excellent safety/tolerability, few drug interactions and once daily, oral dosing, Sofosbuvir (SOF)/Ledipasvir (LDV) have had excellent efficacy in randomized controlled trials and offer great promise for the treatment of hepatitis C in HIV/HCV coinfected patients who are at high risk for progressive liver disease and HCV-related mortality. In a carefully controlled study conducted at the National Institutes of Health Clinical Center, the fixed-dose combination tablet of SOF/LDV lead to high rates of HCV cure in 50 patients with HIV-infection. While the availability of SOF/LDV has great promise for the treatment of patients, the experience with antiretroviral therapy (ART) for the treatment of HIV infection indicates that interferon-free oral therapy is necessary but not sufficient to cure HCV in the real world. While removal of Interferon increases the proportion of coinfected IDUs eligible for treatment, multiple barriers will remain (e.g., medical/psychiatric illness, substance abuse and social constraints). Effective ART in coinfected IDUs provides a strategic framework for the delivery of curative HCV treatment; novel and effective strategies of delivering this care for HCV must be evaluated, including incentives and peer-mentoring.