Atherosclerosis has been described as a liver disease of the heart. The liver is the central regulatory organ of lipid pathways but since dyslipidaemias are major contributors to cardiovascular disease and type 2 diabetes rather than liver disease, research in this area has not been a major focus for hepatologists. Virus-host interaction is a continuous co-evolutionary process involving the host immune system and viral escape mechanisms. One of the strategies HCV has adopted to escape immune clearance and establish persistent infection is to make use of hepatic lipid pathways. This review aims to: update the hepatologist on lipid metabolism; review the evidence that HCV exploits hepatic lipid pathways to its advantage; discuss approaches to targeting host lipid pathways as adjunctive therapy.