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Despite the long-term morbidity associated with hepatitis C and the availability of effective treatment, fewer than a quarter of infected individuals are treated with antiviral therapy. While this is partly related to inherent limitations of currently available medications and the underlying patient population, numerous health system barriers also exist. Fewer than half of chronic hepatitis C infections are diagnosed, relatively few are referred for treatment, and misperceptions about the disease and its treatment abound amongst patients and physicians alike. This article will discuss patient and physician factors that contribute to the undertreatment of chronic hepatitis C.