Viral hepatitis co-infections with tuberculosis in India: A systematic review and meta-analysis

Background and objectives: Tuberculosis (TB) and viral hepatitis (hepatitis B and C) co-infection is a significant threat in low-and middle-income countries like India. To optimise treatment protocols and prevent liver-related complications, it is essential to estimate the burden of these co-infections. This systematic review and meta-analysis were conducted to determine the prevalence of hepatitis B and C co-infection with tuberculosis in India. Methods: In line with PRISMA guidelines, a systematic search of PubMed, Scopus, Embase, CINAHL, and Web of Science was conducted for English-language observational studies published up to January 6, 2026, that reported hepatitis B or C co-infection among TB patients in India. Pooled prevalence estimates were calculated using a random-effects model, heterogeneity was assessed using the I2 statistic, and risk of bias was evaluated using the Joanna Briggs Institute (JBI) critical appraisal tool. Results: A total of 11 studies with 4502 participants reporting hepatitis B or C co-infections in among TB patients in India were included. The pooled prevalence of hepatitis B was 10% [95% Confidence Interval (CI):5%-16%], while the pooled prevalence of hepatitis C was 6% (95% CI:5%-7%). Among TB patients co-infected with HIV, the pooled prevalence of hepatitis B was 17% and pooled prevalence of hepatitis B among drug-resistant TB patients was 11%. Higher rates were reported in Southern and Western India. Interpretation and conclusions: High prevalence of hepatitis B and C co-infections among TB patients in India suggests the need for integrated screening and management of these co-infections within the national programme strategies.