Patients with hepatitis C and inherited bleeding disorders frequently developed end-stage liver disease, with advanced age, HIV coinfection and alcohol abuse significantly increasing their risk in a recent study. The increasing number of patients diagnosed with ESLD and the large beneficial effect of successful antiviral treatment on reducing ESLD risk underline the importance of careful follow-up of the extent of liver damage and timely consideration of antiviral treatment in HCV-infected patients with inherited bleeding disorders. In many patients who previously declined treatment or who underwent unsuccessful treatment in the past, treatment options could be reconsidered in light of the availability of new treatment regimens with increasing success rates.