OBJECTIVES: Hepatic impairment from chronic hepatitis C (CHC) has significant implications for drugs that are extensively cleared by liver, presenting extra challenges to manage comorbidities for CHC patients. This study is to assess the comorbidity burden of hepatitis C virus (HCV) infection in Europe to better understand the needs for proper disease management of patients with CHC. METHODS: National Health and Wellness Survey (NHWS) is an annual cross-sectional survey from representative adults, including information regarding health care attitudes, behaviors, demographic and disease characteristics, resource utilization, and health-related outcomes. In this study, NHWS data obtained from France, Germany, Italy, Spain, and UK in 2006-2008 were analyzed and self-reported CHC were categorized as cases. Propensity-matched non-CHC survey responders were selected as controls based on country, gender, age, education, employment, and year of survey. Conditional logistic regression was applied controlling for HIV, marital status, smoking status, alcohol consumption and body mass index. RESULTS: The final sample included 864 cases and 864 closely matched controls: 61% were male with mean age of 49.8. After adjusting for HIV status, the most prevalent conditions ever experienced by CHC patients included hypertension (27%), high cholesterol (17%), diabetes (12%), chronic bronchitis (11%), arthritis (10%), hepatitis B (10%), thyroid disorders (10%), cancer (9%), and ulcer (gastric or duodenal - 9%). Compared to the control adjusting for HIV status and other covariates, CHC patients were associated with significantly higher risks for 32 medical conditions collected in the survey. CONCLUSIONS: CHC patients have a high burden of comorbidities, many of which require long-term or intensive pharmacological management. This could suggest that treating HCV infection early to prevent the deterioration in liver function is essential for the management of comorbid conditions, and should be among the key goals of comprehensive CHC management strategies.