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Background: Tuberculosis [TB] and hepatitis C virus [HCV] infections are both common infectious diseases. Although HCV infection is frequent in patients with TB, few studies have been conducted worldwide and there is still little evidence concerning this topic. Aim of the work:To assess the prevalence of HCV infection among tuberculous patients and to investigate its impact on tuberculosis and its treatment outcome. Patients and Methods:A cross-sectional study was done on 500 tuberculous patients. Socio-demographic data, clinical history and examination, clinical severity, response to drugs, laboratory and radiological investigation, Tuberculin skin test, and HCV screening were done.Results: HCV infection was detected among 54 tuberculosis patients [10.8%]. HCV-positive patients suffered more from almost all clinical presentation than HCV-negative patients but without statistical significant difference. Tuberculin skin test induration and reactions were more in HCV-negative patients with 17.9 ± 4.9 mm compared to 12.9 ± 2 mm in HCV-positive patients. Lung cavitation and lung infiltration were the most predominant radiological finding among HCV-positive patients. CAT [category] IV and modified CAT I were the most treatment regimen used in HCV-positive patients. Failure of treatment was significantly higher among HCV-positive patients [59.3%] compared to 9.9% of their counterparts. Moreover, multidrug resistance [MDR] and rifampicin resistance were significantly higher in HCVpositive group than their comparable group [31.5% and 29.6%, and 9% and 4.3% respectively]. Conclusion:Co-infection of HCV in Patients with TB is frequent. It increases the frequency of almost all clinical presentation and had its predominant findings on laboratory and radiological investigations. Co-infection also alters the response to TB treatment and should be screened among tuberculous patients before treatment and closely monitored during treatment to detect early any drug resistance or treatment failure.