Steatosis is a common finding in patients with chronic hepatitis C (CHC) due to a combination of the direct steatogenic effect of hepatitis C virus (HCV) and the prevalence of metabolic risk factors in the HCV population. Steatosis is now established as a risk factor for disease progression in CHC and significantly impacts therapeutic response. Research efforts should continue to focus on defining the complex viral and host interactions involved in the pathogenesis of HCV-related steatosis so that future therapeutic strategies may be accurately and appropriately targeted.