Background: Tuberculosis (TB) remains a significant public health issue globally, with an estimated 10 million people affected and 1.4 million deaths annually. The presence of comorbidities like diabetes mellitus, HIV infection, and chronic obstructive pulmonary disease (COPD) complicates TB management, influencing disease progression and treatment outcomes. This study aims to evaluate the prevalence of comorbidities among TB patients and their impact on disease progression in Chhattisgarh, India. Methods: A prospective observational study was conducted at a tertiary care hospital in Chhattisgarh from January to December 2023. Data were collected from 200 confirmed TB patients using a structured questionnaire. The study assessed demographic details, clinical history, comorbidities, and TB treatment outcomes. Statistical analyses included descriptive statistics, chi-square tests, t-tests, and multivariate logistic regression. Results: Among the 200 patients, 40% were aged 31-45 years, and 60% were male. Comorbidities included diabetes mellitus (25%), COPD (10%), hypertension (7.5%), and HIV infection (3.5%), with 54% having no comorbidities. Recovery rates were highest in patients without comorbidities (79.6%) and lowest in those with HIV (42.9%). The 6-month treatment regimen had the highest recovery rate (92.3%). Significant predictors of disease progression included age, diabetes, and HIV infection. Conclusion: Comorbidities significantly impact TB outcomes, with diabetes and HIV infection posing substantial risks. Shorter treatment durations are more effective. Integrated care approaches are essential for managing TB and its comorbidities, improving treatment success and patient care.