Abstract Access to direct acting antivirals (DAAs) may be associated with reductions in hepatitis C virus (HCV) viremia prevalence among people with human immunodeficiency virus (PWH). Among 3755 PWH, estimated HCV viremia prevalence decreased by 94.0% from 36% (95% confidence interval CI, 27%–46%) in 2009 (pre-DAA era) to 2% (95% CI, 0%–4%) in 2021 (DAA era). Male sex, black race, and older age were associated with HCV viremia in 2009 but not in 2021. Injection drug use remained associated with HCV viremia in 2009 and 2021. Targeted interventions are needed to meet the HCV care needs of PWH who use drugs. Among 3755 people with HIV, availability of direct acting antivirals (DAA) was associated with a reduction in HCV viremia prevalence from 36% in 2009 (pre-DAA era) to 2% in 2021 (DAA era) and changes in characteristics associated with HCV viremia.