End-stage liver disease due to hepatitis C virus has become a major challenge in the management of HIV/HCV-coinfected patients. The diagnosis and management of cirrhosis and its complications in the scenario of HIV/HCV-coinfection are reviewed. Noninvasive approaches to the diagnosis of cirrhosis, such as biomarkers or transient hepatic elastography, may be considered. The clinical profile of cirrhosis decompensation in the coinfected population is different from that found in HCV-monoinfected individuals. Ascites and hepatic encephalopathy are much more frequent, whereas hepatocellular carcinoma is still uncommon, when simultaneous hepatitis B virus infection is absent. The newest and more conflicting topics on the management of these complications are also discussed. Liver transplantation seems to be a proper option of treatment in HIV/HCV-coinfected patients and should be considered early in their management, since mortality after the first hepatic decompensation is high.