<![CDATA[General Background Tuberculosis remains a major global infectious disease requiring prolonged anti-tuberculosis drug therapy. Specific Background First-line therapeutic regimens containing isoniazid, rifampicin, and pyrazinamide commonly induce drug-induced liver injury, which requires clinical monitoring through serum glutamic oxaloacetic transaminase and serum glutamic pyruvic transaminase levels. Knowledge Gap Although transaminase elevations are frequently observed during treatment, variations in the onset, severity, and predisposing risk factors across diverse clinical populations require systematic synthesis. Aims This literature review evaluates alterations in transaminase enzyme levels as indicators of hepatic function in tuberculosis patients undergoing drug therapy. Results Synthesis of twenty empirical studies published between 2020 and 2025 demonstrates that transaminase elevations occur predominantly during the intensive treatment phase, with significant risk exacerbation observed in elderly patients, prolonged therapy durations, specific drug regimens, and underlying hepatic comorbidities. Novelty Systematic mapping of multi-study evidence clarifies the transition dynamics between transient adaptive enzyme elevations and severe drug-induced hepatotoxicity across different treatment phases. Implications Routine monitoring of liver transaminase parameters is essential for early detection of drug-induced liver injury and ensuring therapeutic safety in tuberculosis management. Key Findings Highlights Transaminase Elevation Occurs Predominantly During Intensive Therapy Phase Advanced Age And Hepatic Comorbidities Exacerbate Hepatotoxicity Risk Periodic Enzyme Monitoring Ensures Patient Safety During Tuberculosis Treatment Keywords Tuberculosis, Anti-Tuberculosis Therapy, Transaminase Enzymes, Hepatic Function, Hepatotoxicity]]>
