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Open Forum Infect Dis. 2018 Oct 10;5(11):ofy253. doi: 10.1093/ofid/ofy253. eCollection 2018 Nov.

Evaluation of Tuberculosis Treatment Response With Serial C-Reactive Protein Measurements.

Author information

1
Department of Internal Medicine, Edendale Hospital, University of KwaZulu-Natal, Pietermaritzburg, South Africa.
2
Division of Medicine, Department of Infectious Diseases, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
3
Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut.
4
Section of Infectious Disease, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut.
5
School of Clinical Medicine, Nelson R Mandela (NRMSM) Campus, University of Durban, South Africa.
6
Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa.

Abstract

Background:

Novel biomarkers are needed to assess response to antituberculosis therapy in smear-negative patients.

Methods:

To evaluate the utility of C-reactive protein (CRP) in monitoring response to antituberculosis therapy, we conducted a post hoc analysis on a cohort of adults with symptoms of tuberculosis and negative sputum smears in a high-tuberculosis and HIV prevalence setting in KwaZulu-Natal, South Africa. Serial changes in CRP, weight, and hemoglobin were evaluated over 8 weeks.

Results:

Four hundred twenty-one participants being evaluated for smear-negative tuberculosis were enrolled, and 33 were excluded. Two hundred ninety-five were treated for tuberculosis (137 confirmed, 158 possible), and 93 did not have tuberculosis. One hundred and eighty-three of 213 (86%) participants who agreed to HIV testing were HIV positive. At week 8, the on-treatment median CRP reduction in the tuberculosis group (interquartile range [IQR]) was 79.5% (25.4% to 91.7%), the median weight gain was 2.3% (-1.0% to 5.6%), and the median hemoglobin increase was 7.0% (0.8% to 18.9%); P < .0001 for baseline to week 8 comparison of absolute median values. Only CRP changed significantly at week 2 (median reduction [IQR], 75.1% [46.9% to 89.2%]) in the group with confirmed tuberculosis and in the possible tuberculosis group (median reduction [IQR], 49.0% [-0.4% to 80.9%]). Failure of CRP to reduce to ≤55% of the baseline value at week 2 predicted hospitalization or death in both tuberculosis groups, with 99% negative predictive value.

Conclusions:

Change in CRP may have utility in early evaluation of response to antituberculosis treatment and to identify those at increased risk of adverse outcomes.

KEYWORDS:

C-reactive protein; HIV; response to antituberculosis therapy; tuberculosis

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