Chronic infection with hepatitis C virus is nowadays responsible for many cases of liver disease. According to recent research, it seems to be characterized by a great deal of metabolic abnormalities, most of them due to insulin resistance, which is present in the virus C-induced disease more often than in chronic hepatitis B or in the general population. As insulin resistance significantly impairs the natural course of the viral disease by reducing the efficacy of antiviral treatment and aggravating the development of fibrosis, it becomes more and more plausible that therapeutic intervention aiming to reduce it might contribute to a better course in many patients. Hepatic steatosis is also a frequent feature of chronic hepatitis C, being either induced by the infection with genotype 3 or by a predisposing metabolic background. The relation between steatosis and viral disease prognosis is controversial, probably due to the various factors inducing lipid accumulation. A better understanding of the metabolic substrate of chronic hepatitis C would help developing new approaches in its diagnosis and therapy, hopefully providing a better future to many patients.