Hepatic steatosis is common in patients with chronic hepatitis C virus (HCV) infection. Epidemiologic studies have shown HCV-associated steatosis to correlate with both patient factors, such as obesity and viral factors, such as HCV genotype 3a. Furthermore, the degree of steatosis has been linked to the extent of hepatic fibrosis in several studies, implying that steatosis may be contributing to disease progression in chronic HCV infection. Whether the pathogenesis of HCV-associated steatosis is linked to oxidative damage non-specifically, to HCV viral properties, or to other factors remains unknown. This steatosis may play an important role in the response to HCV therapy, in disease progression after liver transplantation for HCV, or in HIV-HCV coinfection.