Patients with transfusion-dependent haemoglobinopathies, such as thalassaemia major (TM) and sickle/β-thalassaemia (S/βThal), have a high risk of hepatitis C virus (HCV) infection. Chronic hepatitis C (CHC) is the major cause of liver disease (Di Marco et al, 2010). Genome-wide association studies (GWAS) detected a single nucleotide polymorphism (SNP) on chromosome 19q13, 3 kilobases (kb) upstream of the IL28B gene (−3 kbC>T, IL28B rs12979860) (Suppiah et al, 2009; Tanaka et al, 2009; Thompson et al, 2010). This SNP is associated with HCV-RNA spontaneous clearance and is in linkage disequilibrium with a non-synonymous variant in IL28B exon 2 (K70RA>G) (Ge et al, 2009; O’Brien, 2009; Thomas et al, 2009; Rauch et al 2010). Treatment of chronic HCV infection in TM and S/βThal patients with pegylated-interferon-α2 and ribavirin (PEG-IFN-α/RBV) could be compromised by severe adverse side effects (SAEs), i.e. ribavirin-associated haemolysis (Sherker et al, 2003; Inati et al, 2005; Di Marco et al, 2010). Therefore, in this cohort of patients, the prediction of spontaneous C virus clearance could be crucial. This study analysed the variants IL28B rs12979860 and K70R to evaluate their allele frequencies and to correlate them to HCV clearance in a cohort of 42 not consecutive patients with TM and S/βThal who were evaluated for possible antiviral Interferon-Ribavirin treatment. HCV natural clearance was defined as the lack of HCV-RNA detection in the serum of the patient in absence of antiviral therapy. All of the patients studied had been previously infected, and all patients who cleared HCV were HCV-RNA positive before becoming negative. It was not possible to calculate the median range of time elapsed from infection to the clearance of HCV in the serum because all of the patients were infected before 1990, when HCV had not been detected and the serum test was not available worldwide. The sensitivity of the polymerase chain reaction (PCR) used to determine serum HCV- RNA concentration was 15 iu/ml. Forty-two patients who had not been treated with PEG-IFN-α/RBV were included in this study. The demographic and clinical characteristics of the 42 studied patients are summarized in Table I. Genomic DNA was extracted from peripheral blood. The DNA variants, IL28B rs12979860 and K70R, were investigated by direct genomic sequencing, endonuclease digestion and reverse dot-blot hybridization. Specific PCR primers were developed in-house on the basis of the IL28B gene map (GENATLAS) and FASTA SNP sequences. According to the literature, the genotype IL28B rs12979860CC/K70RAA was considered to be most frequently associated with spontaneous HCV-RNA clearance, whereas the genotypes IL28B rs12979860TT/K70RGG and IL-28B rs12979860CT/K70RAG were most frequently associated with a persistent infection (Ge et al, 2009; O’Brien, 2009; Thomas et al, 2009; Rauch et al 2010). Allele frequencies of IL28B rs12979860 C>T polymorphism were 63·1% for the C allele and 36·9% for the T allele. Allele frequencies for the K70R variant were 63·1% for the A allele and 36·9% for the G allele. Twenty out of 42 patients (47·6%) showed a spontaneous HCV-RNA clearance: 15 out of 20 (75%) had the genotype IL28B rs12979860 CC/K70RAA, five out of 20 (25%) had IL28B rs12979860CT/K70RAG (Table II). Six out of 20 patients who showed HCV-RNA clearance were also anti-HCV negative: five out of six had the genotype IL28B rs12979860 CC/K70RAA, and the remaining patient had IL28B rs12979860 CT/K70RAG. Twenty-two of 42 patients (52·4%) showed HCV-RNA persistence: 13 out of 22 (59·1%) showed a viral genotype 1b and IL28B rs12979860 CT/K70RAG; four out of 22 (18·2%) showed a viral genotype 1b and IL28B rs12979860 CC/K70RAA; four out of 22 (18·2%) showed IL28B rs12979860 TT/K70RGG (three with viral genotype 2a2c and one with viral genotype 1b); one patient had a viral genotype 2a2c and IL28B rs12979860 CC/K70RAG (Table II). About 30% of individuals who acquire HCV infection resolve their viraemia, leaving only the antibody response as a marker of prior exposure (O’Brien, 2009). In our study, 47·6% of patients had a spontaneous HCV-RNA clearance showing a discrepancy with the natural clearance rate in the general population, which includes mainly non-thalassaemic subjects Therefore, the difference in the rate of HCV-RNA clearance could be due to the disease in which infection occurred. Moreover, it may be possible that chelation treatment, in determining binding of iron, which is essential for the function of polymerase enzymes, could facilitate HCV-RNA clearance. In conclusion, IL28B genotype seems to play a role in natural clearance of HCV-RNA: 15 out of 20 (75%) untreated patients who showed a spontaneous HCV-RNA clearance had a genotype favouring viral clearance (IL28B rs12979860CC/K70RAA) (Table II). Our data suggest that, having confirmed the mean time from infection to HCV clearance, a wait-and-watch approach should be used in patients with haemoglobinopathies and a favourable IL28B genotype until liver damage occurs, defined as an increase of serum ALT levels >2 times normal limits for 6 months that is not related to iron overloading.