The metabolic syndrome and chronic hepatitis C are two common diseases whose impact on public health is globally on the rise. The interaction between these two nosological entities is complex. While infection with hepatitis C virus (HCV) is associated with the development of a fatty liver and insulin resistance – which can lead to overt type 2 diabetes in predisposed individuals – on the other hand metabolic syndrome negatively influences the progression of hepatitis C to cirrhosis and hepatocellular carcinoma. Several recent studies also show that hepatitis C is associated with an increased risk of cardiovascular events. The knowledge of the relationship between HCV and glucose and lipid metabolism is therefore of fundamental importance both for the specialist and the general practitioner. The management of patients with hepatitis C and metabolic abnormalities requires the implementation of specific measures relating primarily to lifestyle. In this issue of Hot Topics in Viral Hepatitis all these points are analyzed in detail by various specialists in the field: from the epidemiological surveys – which emphasize the close relationship between hepatitis C, type 2 diabetes, and cardiovascular events – to those in pathophysiology and practical management.