Prevalence of hepatitis B and C among patients with tuberculosis during the COVID-19 pandemic era and war: challenges, systemic risks and epidemiology prognosis (analytical literature review)

Abstract

Tuberculosis (TB) and viral hepatitis B (HBV) and C (HCV) remain a pressing global health problem. According to WHO, in 2023, approximately 296 million people will be living with chronic HBV infection, and 58 million with chronic HCV infection. Patients with TB are at increased risk of co-infection with viral hepatitis, which complicates treatment due to the increased risk of hepatotoxicity of anti-TB drugs.
The literature review analyzed current data on the prevalence of markers of viral hepatitis B and C among patients with tuberculosis. Global, European and Ukrainian co-infection rates, as well as risk factors for their occurrence, were considered. Systematic reviews and meta-analyses (2015–2025) indicate an increased prevalence of HBV and HCV among TB patients compared to the general population, especially in groups with high social risk and among people with HIV infection. The presence of HBV or HCV is associated with an increased risk of drug-induced liver injury during anti-TB therapy, highlighting the need for early screening and personalized patient management.
The military actions in Ukraine have created additional risks for the spread of infectious diseases. Before the start of the full-scale war, Ukraine was already among the countries with a high burden of multidrug-resistant TB. The war led to the destruction of the medical infrastructure, interruption of treatment of patients with TB and chronic viral hepatitis, large-scale internal and external migration of the population, and a decrease in coverage of preventive programs. And the interruption of anti-TB therapy increases the risk of developing drug-resistant forms of TB, while interrupted HCV treatment can lead to the progression of liver fibrosis.
Current international data (2020–2024) confirm that co-infection of viral hepatitis B and C with tuberculosis is a common and clinically significant problem, especially in Europe. Mandatory screening for HBsAg and anti-HCV before starting anti-tuberculosis treatment is pathogenetically justified and appropriate for timely stratification of the risk of developing hepatotoxic reactions. Management of patients with combined pathology requires a multidisciplinary approach involving phthisiologists, infectious disease specialists and gastroenterologists, as well as regular laboratory monitoring of the functional state of the liver. Given the relevance of the problem for Ukraine, including the Transcarpathian region, it is advisable to further conduct regional epidemiological studies to clarify the prevalence of co-infection and optimize clinical algorithms for patient management.