Thalassemia is an inherited blood disorder characterized by decreased or absent globin-chain production. With nearly 60,000 individuals affected every year, thalassemia is one of the most common genetic diseases in the world. 1 The lifelong need for blood transfusions in thalassemia makes these patients vulnerable to transfusion-transmitted viral infections, notably hepatitis C virus (HCV). Infection with HCV results in chronic infection in a vast proportion of individuals, and the prevalence rate of chronic hepatitis C in patients with thalassemia major in the EMRO (WHO Regional Office for the Eastern Mediterranean) region ranges from 11% to 69% depending on the age of the patient and the local seroprevalence of HCV ( Fig. 1). 2,3 Although the natural history of chronic HCV infection in patients with thalassemia is unclear, the morbidity and mortality of those patients is thought to be increased. Liver disease is more severe in patients with thalassemia and may be accelerated by hepatic siderosis. Hepatic iron overload, in transfusion-dependent thalassemia, negatively affects the outcome of liver disease, leading to more severe hepatic inflammation and fibrosis, and is associated with a diminished response to interferon-based regimens. 2,[4][5][6] Treatment of HCV in patients with thalassemia is aimed at viral eradication, resolution of liver inflammation and control or reversal of fibrosis, reduction of the risk for hepatocellular carcinoma, and improvement of healthrelated quality of life and survival. However, the major impediment to the treatment of HCV infection in patients with transfusion-dependent thalassemia has been the risk for ribavirin (RBV)-associated hemolysis, as well as the effect of iron overload on virological response rates and the potential for drug-drug interactions with various iron chelators. Initial studies using interferon monotherapy had shown a sustained viral response rate of ~30%, 7-9 whereas limited case series confirmed that the addition of RBV with