The hepatitis C virus (HCV) is one of the most important causal agents of liver disease. Genotype 4 is responsible for 20% of chronic hepatitis and in several countries of the Mediterranean area it has been reported that the prevalence is increasing. The HCV infection develops to chronicity in more than 90%, 20% may have cirrhosis and 5-10% develop hepatocellular carcinoma. There has been speculation about a possible association of genotype 4 with the development of hepatocellular carcinoma, but it seems related to other concomitant causes of liver disease. Treatment is based on the use of pegylated interferon α-2a (180 mg/week) or pegylated-interferon α-2b (1.5mg/kg/wk) plus ribavirin (1000-1200 mg/day) for one year. With this regimen, there have been reported sustained virological response (SVR) rates around 65%. There are differences in the SVR rates according to the degree of fibrosis, associated concurrent infections and the presence of specific serologic markers. Nitazoxanide has been used in combination with the classic combination therapy, achieving an improvement in the results.