The burden of chronic hepatitis C infection remains significant in the United States and worldwide. Increased knowledge regarding the natural history of acute and chronic infection and the key factors responsible for disease progression, risk for cirrhosis, and risk for hepatocellular carcinoma are critical in guiding secondary and tertiary prevention measures. The past decade has seen substantial improvement of antiviral therapy for chronic hepatitis C virus with an increasing number of individuals achieving viral eradication. Decisions regarding whom, when, and how to use antiviral therapy have become more complex and change as new studies become available. This review focuses on the current status of hepatitis C virus patient management and future treatment directions.