This complex case is of an ageing HIV positive patient, who had been a management challenge to a multidisciplinary team over the past decade in Adelaide, South Australia. He had various comorbidities and had developed various other infections, mostly sexually acquired, complicating his management. The patient was diagnosed as HIV positive in 1985 and commenced on HAART in 1989. He relocated to Adelaide in 2002. His major issues at that time were sexual dysfunction and bipolar affective disorder. On routine screening mid 2005, his CD4 count had dropped. Liver function tests were abnormal with raised GGT, ALT and AST. Subsequently, he was found to be Hepatitis C positive (Genotype 3). He adamantly denied intravenous drug use but had unprotected anal intercourse with other men. He also had a Prince Albert ring inserted. The hepatitis C infection was apparently acquired sexually. He proceeded to have multiple sexual partners interstate and overseas. On return to Adelaide at the end of 2005, he was found to be syphilis EIA positive, RPR 1:32 and FTA IgG positive. He was treated with benzathine penicillin. Management of his hepatitis C initially involved changes to his HAART over the next 2 years before he finally decided to commence interferon and ribavarin therapy for his Hepatitis C co-infection. He was on treatment for 6 months, with close monitoring by the team psychiatrist in view of his psychiatric comorbidities. To date, he has maintained sustained virological response. An overview of HIV/Hepatitis C co-infection from recent literature review will also be presented.