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The present study was taken up to evaluate the pattern of disease progression and survival in a group of HIV-1 positive children, coinfected with HCV infection (n=25) in comparison to those without such coinfection (n=23). There was a significant negative correlation between the rate of decline of the CD4 + T cell percentage and the duration of the AIDS-free interval in most (80.0 per cent) of the HCV seropositive children showing such decline (r=−0.588; p=0.005). The HCV seropositive children had twofold higher risk of progression to development of AIDS than HCV seronegatives (RR=2.51; 95 per cent CI:1.34–4.69; p=0.004). There was a significant negative correlation between the rate of decline of CD4 + T cell percentage and overall survival duration for HCV seropositive group (r=−0.609; p=0.003). Moreover, children coinfected with HCV had more than twofold higher risks of death than those without HCV (RR=2.39; 95 per cent CI:1.17–4.89; p<0.01). It appears that HCV infection may be an important contributor to the rapid disease progression and increase in mortality in HCV-HIV-1 coinfected children of thalassemia major.