HCV is a major health problem in Egypt. Combined therapy withpegylated interferon and ribavirin is the only evidence basedtreatment to HCV genotype 4. Insulin resistance is linked to nonresponse to combined therapy. The study was carried out to study theeffect of adding metfurmin to the combined therapy in patients withinsulin resistance. Statistical studies were carried out on two groups.One group took triple therapy with pegylated interferon, ribavirin,and metfurmin. The second group took combined therapy. Statisticalanalysis revealed no significant dffirence between the two groups atweek 72 (SVR).