Prevalence of hepatitis B and C infection markers in patients with β-thalassaemia: a systematic review and meta-analysis

Transmission of Hepatitis B and C through blood transfusions remains a major challenge among β-thalassaemia. This systematic review and meta-analysis aimed to discover the prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) markers among these patients. Scopus and PubMed databases were searched on 30th October 2025 for English-language studies published within the preceding 10 years that reported the prevalence of HBV and HCV. The primary outcomes were hepatitis B surface antigen (HBsAg) positivity, anti-HCV seroprevalence, and HCV RNA positivity. Reporting quality and risk of bias were assessed using STROBE and the JBI Critical Appraisal Checklist, respectively; heterogeneity was evaluated using Cochran’s Q and I 2 statistics, and publication bias was assessed using funnel plots and Egger’s regression test. Overall, 260 records were retrieved from the databases, of which 37 observational studies met the eligibility criteria. Among 25 studies comprising 10,130 patients, the pooled prevalence of HBsAg positivity was 4% (95% CI 3–5%; I 2 = 84.5%). Across 34 studies including 10,527 patients, anti-HCV seroprevalence was 22% (95% CI 17–27%; I 2 = 96.3%). Sixteen studies comprising 3,867 patients reported HCV RNA results, with a pooled prevalence of active HCV infection of 13% (95% CI 8–22%; I 2 = 97.2%). Substantial heterogeneity was observed in all three outcomes. Country and region were significant sources of variation for anti-HCV and HCV RNA prevalence, with higher pooled estimates in South Asian and North African regions and lower estimates in the Middle East. Sensitivity analyses supported the robustness of outcomes. Most included studies were classified as having moderate risk of bias (35/37), while two studies were classified as low risk. In conclusion, HCV infections were detected in a clinically significant proportion of β-thalassaemia patients. HBV prevalence was lower but not negligible. Continued donor screening, HBV vaccination, routine HCV surveillance, and confirmatory HCV RNA of anti-HCV-positive patients remain essential in chronically transfused β-thalassaemia patients.