<![CDATA[Tuberculosis (TB) remains a major global health burden. Despite the high efficacy of first-line anti-tuberculosis therapy, treatment is frequently complicated by drug-induced liver injury (DILI), particularly in patients with pre-existing liver dysfunction. This review aimed to evaluate the balance between treatment efficacy and hepatotoxicity during TB therapy in patients with liver dysfunction and to summarise current management strategies. A literature review was conducted using studies retrieved from Scopus, PubMed, and Google Scholar. Articles published between 2015 and 2025 were identified using predefined search terms. After applying inclusion and exclusion criteria, ten eligible studies were qualitatively synthesised. The findings identified baseline liver dysfunction, hepatitis C co-infection, metabolic-associated steatotic liver disease, alcohol consumption, and poor nutritional status as major risk factors for hepatotoxicity. DILI was consistently associated with treatment interruption, regimen modification, delayed recovery, and reduced therapeutic success. Regular liver function monitoring, risk stratification, individualised treatment adjustments, and selective use of hepatoprotective agents were reported to minimise hepatotoxicity while preserving treatment effectiveness. Patient-centred, risk-based management and early identification of high-risk individuals are essential to optimise clinical outcomes and safely maintain effective anti-tuberculosis therapy.]]>
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