<b>Appendix </b>for Risk factors for viral hepatitis in pulmonary tuberculosis patients undergoing treatment: A systematic review and meta-analysis

Liver injury in tuberculosis patients, associated with noncompliance to treatment, is further exacerbated by viral hepatitis, which not only directly harms the liver but also increases susceptibility to drug-induced liver injury. The aim of this systematic review was to analyze the associated risk factors for viral hepatitis in tuberculosis patients. This systematic review and meta-analysis adhere to the PRISMA 2020 statement, and the protocol has been registered with PROSPERO (CRD42023477241). Screening and selection of articles were carried out according to predetermined inclusion and exclusion criteria, utilizing journal databases including Embase, Medline, Scopus, and ProQuest, in November 2023. Baseline characteristic and patient-related risk factor from each included study were extracted, followed by a meta-analysis of factors that potentially exhibit significance, with the heterogeneities also being analyzed. The modified Newcastle-Ottawa Scale was then employed to assess the quality of each included study. [DD1] [DD2] From 21 included studies out of 6,415 identified records, 12 potential risk factors for hepatitis B and 15 for hepatitis C were subjected to meta-analysis. Some key risk factors include HIV (OR 3.42 [2.19–5.34] and 6.99 [5.09–9.61] for hepatitis B and C, respectively, p &lt; 0.01), smoking (OR 1.55 [1.19–2.02] and 3.06 [1.63–5.75] for hepatitis B and C, respectively, p &lt; 0.01), and alcohol consumption (OR 2.38 [1.06–5.37] and 4.32 [2.76–6.78] for hepatitis B and C, respectively, p &lt; 0.05). Furthermore, meta-analysis indicated that other significant risk factors for hepatitis B and/or C include injecting and non-injecting drug use, multiple sexual partners, tattooing, ear-nose piercing, blood transfusion, dental interventions, homelessness, incarceration, living with prisoners, sexually transmitted diseases, and diabetes mellitus . In conclusion, patients with tuberculosis who have risk factors such as smoking, HIV, or alcohol consumption should be screened for hepatitis B and C to prevent liver injury.