The following review evaluates the current data implicating a role for hepatic iron in enhancing the liver injury in patients with chronic hepatitis C infection. Iron removal lowers transaminases, but doesn't appear to improve responsiveness to interferon-alpha therapy. An important effect of iron removal might be to delay progression of liver injury to fibrosis and cirrhosis. Until such a hypothesis is disproven, phlebotomy therapy for even mildly iron-loaded HCV patients is recommended.