Chronic hepatitis C (CHC) and steatosis are common entities that have the potential to interact synergistically and result in significant morbidity. Steatosis is frequently observed in CHC and seems to have a significant impact on the natural history of the disease with respect to development of fibrosis and reducing the virologic response to current therapy. Research efforts should continue to focus on delineating the complex viral and host interactions involved in the pathogenesis of hepatitis C virus (HCV)-related steatosis. This may provide novel future therapeutic strategies that may help modulate disease progression in relation to steatosis in HCV infection.