Objective To compare the risk of hepatitis B virus (HBV) reactivation (HBVr) in hepatitis C virus (HCV)-infected patients receiving direct-acting antiviral agents (DAAs), evaluate the effectiveness of prophylactic anti-HBV treatment in preventing HBVr. Methods Relevant literatures published up to February 13, 2025 were systematically retrieved from China National Knowledge Infrastructure (CNKI), Wanfang Database, PubMed, Embase, and Cochrane Library databases. The literatures were screened according to the established inclusion and exclusion criteria, data were extracted and underwent quality assessment. Revman 5.4 and Stata 18.0 software were used for Meta-analysis, sensitivity analysis, and publication bias assessment. Results A total of 32 studies (31 cohort studies and 1 randomized controlled trial) involving 21 530 HCV-infected patients were included. Twenty-seven studies reported that the incidence of pooled HBVr was 30% (95%CI: 16%-45%) in HCV-infected patients combined with HBsAg-positive after DAAs treatment. Twenty-four studies showed that the pooled HBVr rate was 0 in HCV-infected patients with HBsAg negative but HBcAb-positive. HBVr rates reported in each study ranged from 0 to 15%. Fourteen literatures were chosen to compare the risk of HBVr after DAAs treatment between HCV-infected patients with HBsAg-positive and HCV-infected patients with HBsAg-negative but HBcAb-positive, and the relative risk(RR)=31.06 (95% CI: 17.98-53.65). Among HCV-infected patients with HBsAg-positive, there was no statistically significant difference in the risk of HBVr between the group with HBV DNA < LLOQ (lower limit of quantification) and the group with HBV DNA ≥ LLOQ (RR=0.75, 95% CI: 0.52-1.06). Among HCV-infected patients with HBsAg-positive, the risk of HBVr in patients receiving DAAs treatment combined with nucleoside analogues for prophylactic anti-HBV treatment was only 19% of that in the control group (RR=0.19, 95% CI: 0.06-0.58). Conclusion The HCV-infected patients with HBsAg-positive have a high incidence of HBVr after DAAs treatment. The existing data showed that the estimated value of incidence of pooled HBVr was 0 in HCV-infected patients with HBsAg negative but HBcAb positive after DAAs treatment, yet there were still individual reactivation reports, and the risk was not completely ruled out. The use of nucleoside analogues for prophylactic HBV treatment can reduce the risk of HBVr in HBsAg-positive HCV-infected patients after DAAs treatment. Prophylactic HBV treatment and continuous management of HCV-infected patients are helpful to improve the safety of DAAs treatment and optimize the overall treatment effect.