OBJECTIVES: Hepatitis C is an infectious disease affecting the liver; chronic infection can lead to cirrhosis. The actual standard of care in Italy is Peginterferon+ribavirin. Our aim was to describe treatment patterns, disease progression and resource use in HCV. METHODS: An observational retrospective cohort analysis based on 4 Local Health Units administrative and laboratory databases was conducted. HCV-positive patients between 01/01/2009-31/12/2010 were included and followed-up for one year. To explore which covariates were associated to disease progression (cirrhosis, hepatocellular carcinoma -HCC-, death for any cause), Cox proportional hazards models were performed. RESULTS: 9,514 patients were analyzed, 55.6% male, age 58.1±16.1; 5.8% had HIV, 3.0% HBV, 1.6% HCV+HBV+HIV, 26.1% cirrhosis, 4.3% HCC. Genotypes frequencies were 1a (17%), 1b (34%), 2 (24%), 3 (19%), 4 (5%). Antiviral treatment was not administered to the majority of patients (79%); the main factors affecting this decision were: age >65 years (44%), females (46% VS 40% of treated), cirrhosis (30%), normal liver enzymes (28%), ongoing substance/alcohol abuse (7%), HCC (5%). Disease progression in the observed timeframe was less frequent among treated patients (incidence rate per 100 patients/year: cirrhosis 2.1±0.7 VS 13.0±1.0, HCC 0.5±0.3 VS 3.6±0.5, death for any cause 0.5±0.3 VS 6.4±0.7); at multivariable Cox regression models, hazard ratios were, respectively, 0.30 (0.21-0.43), 0.41 (0.19-0.92) and 0.24 (0.12-0.48) (all p<0.05). For genotype1 subgroup, results were not statistically different between Peginterferon+ribavirin treated and untreated (cirrhosis: HR=0.82 (0.32-2.11), p=0.682). The annual expenditure for HCV management (drugs, hospitalizations, outpatient services) was €4,700 per patient. CONCLUSIONS: Actual standard of care was not widely used, especially for sensitive subgroups such as women and the elderly; in this context, there is an urgent need for treatment, but current therapies do not appear to be adequate for all patients, especially those with genotype1, which represents 60% of the Italian HCV population.