To evaluate the prevalence of hepatitis C virus (HCV) infection and the histopathological aspects of this infection among regular hemodialysis patients, we followed 130 patients on regular dialysis screened for HCV antibodies by enzyme-linked immunosorbent assay (ELISA). Confirmatory testing was done using a second generation recombinant immunosorbant assay (RIBA). Fifty eight patients (44.6%) were antibody positive at the start of the study. There was a significant relationship between the presence of anti-HCV antibody and the increased period on dialysis (54.3 months in the sero-positive group, compared to 22.2 months in the sero-negative group, (P < 0.001). There was no statistical correlation with the history of blood transfusion or the serum iron level. Liver biopsies in eight sero-positive patients with abnormal liver enzymes showed chronic active hepatitis in six and chronic persistent hepatitis in two cases. Such findings of gross hepatic involvement in anti-HCV positive hemodialysis patients strongly support the arguments for antiviral therapy with Interferon in these patients, in the attempt to prevent further hepatic damage, before they receive renal allografts.