Studies of the subtle symptoms associated with chronic diseases and detected by quality of life questionnaires are still in their infancy. The techniques used to examine these impairments in well being are still being developed and their use is far from routine. There is a growing body of evidence to show that patients with chronic hepatitis C virus (HCV) without major disease related complications do perceive themselves to be unwell and do have significant changes in their physical and mental well being. These abnormalities cannot be attributed to the mode of acquisition of the infection or to the severity of liver damage. The mechanism of these changes is unknown but the symptoms do remit following successful therapy, indicating that the presence of the virus plays a role in their aetiology. These symptoms require careful evaluation and may be sufficiently severe to justify therapy in the absence of advancing liver damage. Treatment of chronic HCV significantly impairs a patient's quality of life. The decision as to whether an individual patient's symptoms are sufficient to justify therapy in the absence of progressive liver damage is one which must be based on an assessment of the individual's current and future status as well as the individual's ability to tolerate current therapy.