Inclusion Criteria:

1. Chronic hepatitis C. This is defined as the documentation of the presence of circulating hepatitis C virus by a positive hepatitis C PCR test and a positive HCV genotype test for genotype 1, and a liver biopsy (within the previous 5 years) that is compatible with chronic hepatitis. (Note: no requirement is made for the presence of abnormal transaminases. Patients with persistently normal transaminases are allowed if they meet the definition of chronic hepatitis C above). Liver biopsy data is required on at least 90% of enrolled patients to allow for the potential refusal of patients for the liver biopsy test. In the case of patients that have refused liver biopsies a clinical diagnosis of chronic hepatitis C is required. In the absence of a liver biopsy within five years the clinical diagnosis requires a history compatible with a chronic hepatitis C infection with the documentation of the presence of circulating hepatitis C virus by a positive hepatitis C PCR test and a positive HCV genotype test for genotype 1, and biochemical evidence of prior abnormal transaminases at two times covering a time span of at least 6 months.

2. Positive HCV RNA by PCR, Genotype 1, treatment naive 3. Age 18-65 years. 4. Patient must be able to give informed consent. 5. Eligible for interferon alfa and ribavirin-based antiviral treatment:

1. Negative pregnancy test at entry within 48 hours of starting treatment.
2. Reconfirmation and documentation that sexually active female patients of childbearing potential are practicing adequate contraception. A urine pregnancy test obtained at entry prior to the initiation of treatment must be negative.
3. Reconfirmation that sexually active male subjects are practicing acceptable methods of contraception during the treatment period and for six months following the last dose of study medication.
4. For patients with cirrhosis or stage 4 fibrosis on liver biopsy, they must have an alpha fetoprotein (AFP) value < 80 ng/mL obtained within 3 months prior to entry. Cirrhotics with an alpha fetoprotein value >30 ng/mL but <80ng/mL may be enrolled after a normal ultrasound or triphasic CT scan within the previous 3 months. Cirrhotics with alpha fetoprotein levels up to 30 ng/ml must have an ultrasound or CT scan within 6 months of enrolling that is negative for hepatocellular cancer. Patients with an AFP > 80 ng/mL may not be enrolled. Cirrhotics must have ongoing HCC screening during study.

5. Compensated liver disease with the following laboratory results at entry:

   • Hemoglobin greater than or equal to 12 gm/dL for females and greater than or equal to 13 gm/dL for males
   • WBC greater than or equal to 2,000/mm3
   • Neutrophil count greater than or equal to 1,500/mm3
   • Platelets greater than or equal to 75,000/mm3
   • Albumin > 3.0 g/dL
   • Total bilirubin <2.0
   • Serum creatinine < 1.4 mg/dL
   • INR <1.8
   • If diabetic, must have glycosylated Hgb test that demonstrates adequate control of diabetes in the opinion of the investigator
   • TSH within normal limits (including patients with hypothyroidism controlled by thyroid hormone replacement)

Exclusion Criteria:

1. Patient unable or unwilling to participate.
2. Liver disease in addition to chronic hepatitis C (HBsAg positive, prior diagnosis of or known autoimmune liver disease, hemochromatosis, PBC, PSC, alpha-1 antitrypsin deficiency, Wilson’s disease, etc.)
3. Decompensated liver disease, with history of encephalopathy, variceal bleeding, or ascites or CHILD-PUGH class B or C.
4. Baseline BDI > 19 or current suicidal or homicidal ideation. (Note: if baseline BDI is > 19 pt. will require a psychiatric evaluation and treatment; if deemed stable after this he may be considered according to site PI clinical judgment.)
5. Current substance use disorder (Must be evaluated and demonstrate engagement and compliance with care before they will be eligible).

6. Patients with active or uncontrolled psychiatric disease including:

   o patients who have had recent prior severe psychiatric disease, such as patients who were previously hospitalized with major depressive or bipolar or major psychotic disorder within the last 2 years, and patients who were previously hospitalized for suicide attempts within the last two years,

   • patients with prior traumatic brain injury and persistent deficits related to this, and
   • patients who have a recent (past five year) history of, or who are known to be at risk for, homicidal ideation or assaultive behavior.:
7. Accepted and reasonable exclusion criteria for interferon alfa and ribavirin based treatments:

1) CNS trauma or active seizure disorders requiring medication. 2) Significant cardiovascular dysfunction within the past 12 months 3) Poorly controlled diabetes mellitus (in the opinion of the site PI). 4) Moderate or severe chronic pulmonary disease 5) Clinically significant immunologically mediated disease 6) Hemoglobinopathies (e.g., Thalassemia) or any other cause of hemolytic anemia.

7) Evidence of decompensated liver disease such as a history of or presence of ascites, bleeding varices, or spontaneous encephalopathy or CHILD-PUGH scores B or C.

8) Any medical condition requiring, or likely to require during the course of the study, chronic systemic administration of steroids.

9) Hypersensitivity to interferon alfa or ribavirin 10) Known anti-HIV positive 11) Clinically significant retinopathy 12) Previous solid organ transplantation 13) Any condition that, in the opinion of the investigator, will prevent the patient from being compliant with study medications or appointments.

8. Patients who develop hepatic decompensation during the course of treatment. The PT/INR, total bilirubin, albumin will be repeated at the 24 week interval to allow for a re-calculation of the CHILD-PUGH score. Patients who have developed a score of 7 or greater (CHILD-PUGH class B or greater) be considered for discontinuation of the study.