The mechanisms for hepatic damage in HCV/HIV co-infection are poorly defined. Although intra-hepatic T-cell immune responses are necessary for HCV clearance, they have also been shown to play a central role in mediating hepatocellular injury by direct cytotoxicity or indirectly by releasing cytokines. In this regard, IFN-c has been shown to be anti-fibrogenic, whereas, TNF-a activates hepatic stellate cells, which induce fibrosis, and likely contributes to progression to cirrhosis [6, 7] .