Tuberculosis (TB) remains a major public health issue with 10.6 million incident cases and 1.6 million deaths in 2022. The lack of microbiologically confirmed TB is frequent, especially in resource-limited settings and people with advanced HIV disease, often lead to empirical prescription of tuberculosis treatment. This approach is commonly adopted when a clinical diagnosis is highly suspected. Under these circumstances, physicians require biomarkers to monitor treatment that can immediately and accurately predict treatment outcomes.  Hence, a biomarker that correlates with the treatment response is crucial for patients empirically treated for tuberculosis. In a previous pilot study in Cambodia, we reported that high levels of circulating interleukin-1 receptor antagonist (IL-1Ra) at the time of tuberculosis diagnosis were found in severely immunocompromised adults infected with human immunodeficiency virus (HIV), and a spectacular decrease of IL-1Ra levels after eight weeks of tuberculosis treatment; however, this timeframe is too extended to make clinically significant medical decisions.

In the present study, which is the fruitful collaboration between the ANRS site in Ivory Coast (Côte d’Ivoire), Université Paris Cité (France), and Institut Pasteur du Cambodge (Cambodia),  we demonstrate that circulating IL-1Ra level significantly decreased as early as the first week of initiation of tuberculosis treatment could help clinicians to quickly assess treatment response in patients empirically treated for tuberculosis. 

Thanks to the National Institute of Health and Medical Research (Inserm) ANRS Emerging Infectious Diseases (ANRS|MIE) for sponsoring and funding the study (LILAC-TB ANRS 12394 )