Evaluating C-reactive protein (CRP) and Interferon gamma-induced protein 10 (IP-10) as Biomarkers for Tuberculosis Treatment Monitoring: A Systematic Review on Adult Pulmonary Tuberculosis Treatment

Abstract

Background: Tuberculosis (TB) is an enduring global health menace that predominantly affects low- and middle-income nations. Despite medical advancements, TB continues to claim numerous lives every year, necessitating innovative solutions to enhance treatment and monitoring. Conventional strategies for monitoring the progress and outcomes of TB treatment often face challenges, especially in resource-limited settings. These limitations include delayed results, invasive procedures, and the need for sophisticated equipment. Consequently, the medical community is in dire need of efficient and reliable biomarkers that can serve as indicators of treatment response and disease progression. Objectives: The primary aim of this review was to meticulously investigate the potential effectiveness of C-reactive protein (CRP) and Interferon gamma-induced protein 10 (IP-10) as biomarkers for TB treatment monitoring. Specifically, this review sought to answer: "How effective are CRP and IP-10 in tracking treatment response in adults undergoing therapy for active pulmonary tuberculosis?" Methods: Guided by the stringent PRISMA 2020 statement guidelines, an exhaustive search of the literature was conducted, focusing on studies that shed light on CRP and IP-10 as prospective biomarkers for TB treatment tracking. Multiple databases were scoured, and a rigorous selection protocol was established, filtering out studies based on relevance, language, and other criteria. This meticulous approach ensured the inclusion of only the most pertinent studies that contribute significantly to the research question. Results: Out of an initial pool of 39 articles, six pivotal studies were selected for in depth review. These studies spanned a diverse range of geographical territories, from South Korea and Uganda to India and Gambia, offering a broad spectrum of insights. The collated results indicated that biomarker concentrations, notably IP-10 and CRP, exhibited significant fluctuations in sync with TB treatment stages and overall disease diagnosis. The consistency of IP-10 levels in monitoring therapeutic response was particularly pronounced in patients diagnosed with active TB. On the other hand, CRP levels displayed a discernible downward trend as the treatment progressed, underscoring its potential as a reliable indicator of therapeutic effectiveness. However, certain studies also illuminated the circumscribed role of IP-10 as a biomarker in regions heavily burdened with TB. This highlighted the imperative for context-specific evaluation before the widespread adoption of these biomarkers. Conclusions: The findings of this review underscore the promising potential of both CRP and IP-10 as innovative biomarkers for TB treatment monitoring. While IP-10 exhibits a pronounced capability in differentiating between active and latent TB infections, CRP's consistent decline during treatment suggests its pivotal role in evaluating therapeutic efficacy. Nevertheless, the practical adoption of these biomarkers in real-world scenarios mandates further extensive research, comprehensive validation trials, and tailored evaluations to account for regional and demographic variations. The incorporation of such biomarkers could revolutionize TB treatment monitoring, offering rapid, reliable, and non-invasive methods that could be particularly beneficial in resource-constrained settings.