Aims: Chronic hepatitis C (CHC) is a major comorbidity in patients with hemophilia. the management of hepatitic C virus (HCV) infection and control of various complications are emerging as important factors to increase the long term prognosis of hemophilia patients. Therefore, we assessed the long term outcome of peginterferon plus rivavirin (PEG) and direct acting antivirals (DAA) in HCV patients with hemophilia. Methods: Patients (n=205) were enrolled between March 2007 and July 2019. 141 patients were treated with PEG (genotype 1, n=98; genotype 2, n=42; genotype 3a, n=1). 64 patients were treated with DAA (genotype 1, n=44; genotype 2, n=19; genotype 4, n=1). We evaluated sustained virological response (SVR), incidence of hepatocellular carcinoma (HCC). Results: Mean follow-up periods were 9.9 and 3.4 years in PEG and DAA, respectively. In genotype 1, SVR was 66.3% (65/98) and 90.9% (40/44) in PEG and DAA groups, respectively. In genotype 2, the SVR was 73.8% (31/42) and 89.4% (17/19) in PEG and DAA groups, respectively. HCC developed in 3.5% (5/141) patients treated with PEG. Among them, the mean age was 77 (range 66-83) and 4 patients were genotype 1(genotype 1a : 1, genotype 1b : 3). 3 patients had liver cirrhosis and 2 out of 3 patients (Genotype 1a : 1, genotype 2 : 1) had SVR with PEG. 1 patient who had liver cirrhosis was treated with DAA after 4 years and achieved SVR. However, HCC occurred 2 years later. 3 patients died of brain hemorrhage, pneumonia and leukemia. Conclusions: PEG showed stable SVR and low incidence of HCC after SVR. Although the follow-up period is short, oral DAA treatment showed more stable SVR than PEG and no development of HCC after SVR in CHC patients with hemophilia.