Introduction: Hepatitis C virus (HCV) genotype 4 is the most prevalent in Egypt. Vis-ceral adiposity index (VAI) and (TyG) index are newly developed indices for assess-ment of metabolic syndrome (MS) and insulin resistance (IR). We aimed at comparing their levels in HCV-patients with healthy controls and validate their use for prediction of hepatic histopathological changes. Patient and Methods: 78 chronic HCV-infected patients proven by PCR, viral genotyping and hepatic histopathology, and 67 healthy controls were enrolled. Presence of MS, Homeostasis Model Assessment for IR esti-mation (HOMA-IR), TyG index, and VAI were assessed. Results: HOMA-IR, TyG and frequency of MS were significantly higher in patients’ group (p < 0.0001 for each) in comparison to controls. In HCV patients, increased fasting blood glucose (FBG) was the only strong predictor of severe hepatic necro-inflammation. High FBG, older age, female sex, high AST, TyG, VAI, serum lipids abnormalities and presence of MS were all associated with severe fibrosis on univariate regression analysis. Only high AST, TyG, VAI and LDL were independent predictors of severe fibrosis. A model using the 4 parameters showed a strong validity in predicting advanced hepatic fibrosis (AUC 0.801; CI: 0.705 - 0.897, p < 0001). Female sex, high BMI, VAI, LDL and TG values are all significantly associated with moderate/severe steatosis on univariate analysis. Among them, high BMI and LDL are the strong predictors (AUC 0.738; CI 0.625 - 0.851, p = 0.002). Conclusion: HCV genotype 4 is significantly associated with MS and increased values of HOMA IR and TyG index. TyG index and VAI are valuable simple indices that could predict the histopathological changes in Egyptian CHC pa-tients.