Dolutegravir: safety concerns

Report by Dr M Morgan MB BS BSc July 2025

Dolutegravir: Comprehensive Risk Assessment and Adverse Effects Profile

Recent evidence from real-world clinical studies has revealed a more complex safety profile for dolutegravir than initially demonstrated in controlled clinical trials, with particular concerns regarding blood-brain barrier disruption, neuropsychiatric effects, and metabolic complications. While dolutegravir remains highly effective for HIV treatment, mounting data suggests clinically significant adverse effects that extend beyond the mild side effects reported in pivotal studies, necessitating careful monitoring and individualized risk assessment for patients receiving this antiretroviral therapy.

Blood-Brain Barrier Effects and Central Nervous System Toxicity

Mechanism of Blood-Brain Barrier Disruption

Dolutegravir has been demonstrated to significantly compromise blood-brain barrier integrity through multiple pathways. Research using primary cultures of mouse brain microvascular endothelial cells has shown that dolutegravir at therapeutically relevant concentrations (2,500-5,000 ng/mL) disrupts tight junction proteins including ZO-1, occludin, and claudin-5[1][2]. The mechanism involves activation of endoplasmic reticulum stress pathways, with dolutegravir triggering ER stress sensor proteins (PERK, IRE1) and downstream markers (eIF2α, Hspa5, Atf4)[2][3]. This cellular stress response leads to increased reactive oxygen species production, aberrant mitochondrial membrane potential, and transient calcium flux in brain endothelial cells[2][3].

Gene ontology analysis of RNA sequencing data reveals an enriched transcriptome signature of ER stress pathways following dolutegravir treatment, distinguishing it from other integrase inhibitors like bictegravir, which does not demonstrate similar blood-brain barrier toxicity[1][2]. In vivo studies using sodium fluorescein permeability assays have demonstrated that 14-day chronic treatment with dolutegravir increases blood-brain barrier permeability by approximately 70%, significantly greater than the 40% increase observed with efavirenz[1]. This enhanced permeability facilitates viral entry of free virions and infected monocyte-macrophages, potentially contributing to enhanced cerebral viral infection and inflammatory responses[1].

Cerebrospinal Fluid Penetration and Regional Distribution

Dolutegravir demonstrates variable penetration across different brain regions, with significant implications for both efficacy and toxicity. Postmortem analysis of brain tissue from HIV-infected individuals reveals that dolutegravir achieves highest penetration ratios in the choroid plexus/arachnoid region, while the corpus callosum shows the lowest penetration[4][5]. Median cerebrospinal fluid concentrations range from 9.6 to 18 ng/mL, representing approximately 0.65% of total plasma concentrations[6][7][8][9]. While these concentrations exceed the wild-type inhibitory concentration for HIV by 48-fold, the variability in regional distribution may contribute to differential neurological effects[6][8].

Notably, women demonstrate higher cerebrospinal fluid penetration of dolutegravir compared to men, which may explain the increased vulnerability to neuropsychiatric adverse effects observed in female patients[5]. The relationship between cerebrospinal fluid concentrations and blood-brain barrier integrity shows positive correlation with albumin quotient ratios, suggesting that meningeal inflammation or infection may increase drug distribution into central nervous system compartments[5][8].

Neuropsychiatric Adverse Events

Clinical Presentation and Prevalence

Neuropsychiatric adverse events represent the most clinically significant concern with dolutegravir therapy, occurring at substantially higher rates in real-world practice than in controlled clinical trials. Meta-analysis of cohort studies involving over 6,400 patients across multiple countries demonstrates discontinuation rates due to neuropsychiatric adverse events of approximately 3.5%, with a range of 1.4% to 7.2%[10][11]. A large Ugandan cohort study of 892 adults revealed that 41.7% experienced at least one neuropsychiatric adverse event, with 9.1% experiencing severe to life-threatening symptoms requiring healthcare intervention[12].

The spectrum of neuropsychiatric symptoms is diverse and includes insomnia (the most prevalent symptom), sleep disorders, dizziness, anxiety, depression, headache, paresthesia, muscle-skeletal pain, poor concentration, and slow thinking[13][10][11]. In some populations, anxiety has been reported in up to 30% of cases, depression in 50%, and insomnia in up to 70% of patients[14]. Sleep disturbances appear particularly prominent, with insomnia being the leading cause of treatment discontinuation in several cohort studies[15][11].

Risk Factors and Vulnerable Populations

Certain patient populations demonstrate heightened vulnerability to dolutegravir-induced neuropsychiatric effects. Women consistently show higher rates of neuropsychiatric adverse events compared to men across multiple studies[15][10]. Patients over 60 years of age represent another high-risk group, with elderly patients experiencing more frequent central nervous system side effects[15][10]. Concurrent initiation of abacavir with dolutegravir appears to increase the risk of neuropsychiatric adverse events, possibly due to synergistic effects on cellular stress pathways[15][10].

The relationship between drug exposure and neuropsychiatric effects remains unclear, with studies showing inconsistent correlations between plasma dolutegravir concentrations and symptom severity[10]. However, older patients demonstrate higher dolutegravir exposure in both serum and cerebrospinal fluid, which may contribute to their increased susceptibility[16]. Genetic polymorphisms in dolutegravir-related metabolic pathways are currently under investigation as potential predictors of neuropsychiatric adverse event risk[17].

Renal Effects and Creatinine Elevation

Mechanism of Creatinine Elevation

Dolutegravir causes predictable elevation in serum creatinine through inhibition of renal organic cation transporter-2 (OCT2) and multidrug and toxin extrusion proteins (MATE-2K), which reduces creatinine secretion without affecting actual glomerular filtration rate[18][19]. This pharmacological effect typically manifests within one week of treatment initiation, reaching a plateau at an average increase of 11 mmol/L[20]. Phase I studies using iohexol clearance have confirmed that despite creatinine elevation, measured glomerular filtration rate remains unchanged, indicating that the rise in creatinine represents decreased secretion rather than kidney damage[18].

In clinical practice, the creatinine elevation can be more pronounced than observed in controlled trials. A case report of an HIV-infected kidney transplant recipient showed creatinine elevation from 1.5 mg/dL to 1.8 mg/dL after switching to dolutegravir, initially raising suspicion for acute rejection[18]. The concurrent use of abacavir and lamivudine, which also inhibit renal transporters, may contribute to greater creatinine elevation[18]. For patients with pre-existing renal impairment or single functioning kidneys, the relative impact on creatinine may be more significant[18].

Clinical Implications and Monitoring

Studies comparing different biomarkers of renal function in HIV-infected Chinese patients demonstrate that dolutegravir-containing regimens present significantly higher serum creatinine elevation and decreased estimated glomerular filtration rate based on creatinine (eGFRcr) compared to tenofovir-containing regimens without dolutegravir[19]. However, cystatin C levels and eGFRCysC remain stable, supporting the conclusion that dolutegravir affects creatinine secretion rather than actual kidney function[19].

The proportion of patients experiencing severe eGFRcr decrease (>30% reduction) is significantly higher in dolutegravir-treated groups[19]. This creates a clinical dilemma in distinguishing between pharmacological creatinine elevation and actual nephrotoxicity, particularly in patients receiving nephrotoxic co-medications or those with pre-existing kidney disease[19]. Healthcare providers may need to establish new baseline creatinine levels approximately four weeks after dolutegravir initiation or utilize alternative markers such as cystatin C for accurate renal function assessment[19].

Hepatic Effects and Liver Toxicity

Patterns of Liver Enzyme Elevation

Dolutegravir demonstrates a complex relationship with hepatic function, with effects varying significantly by patient age and co-infection status. Transaminase elevations occur in approximately 5% of patients receiving dolutegravir, generally presenting as mild elevations that occur at similar rates as observed with raltegravir, darunavir-ritonavir, and efavirenz[20]. However, elderly patients aged 60 years and older show significantly greater risk for alanine aminotransferase (ALT) elevation compared to younger patients and those receiving elvitegravir or raltegravir[21].

In patients with hepatitis B or C co-infection, the incidence of transaminase elevation increases substantially to 16%, most likely reflecting immune reconstitution inflammatory syndrome[20]. This elevation rate is lower than observed with raltegravir and efavirenz but higher than seen with darunavir-ritonavir[20]. The temporal pattern shows that ALT elevation typically peaks at week 4 in elderly patients, with median increases of 10 IU/mL, before declining significantly and returning to baseline levels by week 52[21].

Serious Hepatic Complications

While most hepatic effects are mild and reversible, dolutegravir can cause serious liver problems including hepatic failure, particularly in patients with risk factors[22][23]. Clinical manifestations of serious hepatotoxicity include jaundice (yellowing of skin or eyes), dark urine, light-colored stools, nausea, vomiting, loss of appetite, and right upper abdominal pain[22][23]. These symptoms warrant immediate medical evaluation and consideration of treatment discontinuation[22][23].

Patients with concurrent medications or underlying liver disease may be at higher risk for significant hepatotoxicity[22]. The mechanism appears multifactorial, involving direct cellular toxicity, immune-mediated reactions, and metabolic effects[20]. Regular monitoring of liver function tests is recommended, particularly during the first few months of therapy and in high-risk populations[22][23].

Lipid Metabolism and Cardiovascular Effects

Lipid Profile Changes

Contrary to some other antiretroviral agents, dolutegravir generally demonstrates favorable effects on lipid metabolism when compared to certain alternatives like efavirenz. A prospective study of 64 Thai patients with HIV and dyslipidemia who switched from efavirenz to dolutegravir showed significant improvements in lipid profiles at 24 weeks, with decreases in total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides[24]. These changes suggest that dolutegravir may benefit patients at high risk for cardiovascular disease[24].

Comparative studies demonstrate that dolutegravir lacks the elevation in total cholesterol, low-density lipoprotein, and triglycerides typically observed with protease inhibitors[20][25]. Treatment-naïve HIV-infected patients receiving dolutegravir show more favorable lipid profiles compared to those receiving other antiretroviral combinations, making it an appropriate option for older patients who may have additional cardiovascular risk factors[25]. Meta-analyses confirm significantly fewer adverse events with dolutegravir compared to atazanavir-ritonavir, lopinavir-ritonavir, and efavirenz regarding lipid-related complications[20].

Weight Gain and Metabolic Consequences

Despite favorable lipid effects, dolutegravir is associated with significant weight gain that may have long-term metabolic consequences. Studies from African populations demonstrate that people taking dolutegravir-based treatment have substantially higher risk of becoming overweight or obese compared to other antiretroviral regimens, with almost one in ten patients gaining enough weight to be classified as overweight or obese[26]. Clinical trials including ADVANCE and NAMSAL have consistently shown dolutegravir-associated weight gain, with effects being greatest in women, particularly those receiving dolutegravir with tenofovir alafenamide[26].

A review of diverse HIV cohort in London found that 62% of patients gained weight while on dolutegravir, with a 9% average increase among those who gained weight[27]. The weight gain appeared to be independent of lifestyle factors and dietary changes, suggesting a direct metabolic effect of the medication[27]. This weight gain may place patients at higher risk for cardiovascular disease, diabetes, and hypertension, potentially offsetting some of the favorable lipid effects[26]. The mechanism of dolutegravir-induced weight gain remains incompletely understood but may involve effects on appetite regulation, metabolic rate, or fat distribution[26].

Additional Safety Concerns

Allergic and Hypersensitivity Reactions

Dolutegravir can cause serious allergic reactions that require immediate medical attention and treatment discontinuation. Hypersensitivity reactions, while uncommon (occurring in less than 1%), tend to occur shortly after treatment initiation and can be life-threatening[20]. Clinical manifestations include severe rash, fever, general feeling of illness, fatigue, muscle or joint aches, trouble breathing, blisters or sores in the mouth, blistering or peeling skin, redness or swelling of the eyes, and swelling of the mouth, face, lips, or tongue[28][22].

The presentation can be systemic and multi-organ, requiring differentiation from other causes of drug-induced hypersensitivity syndromes[28][22]. Patients developing any rash while taking dolutegravir should contact their healthcare provider immediately, as progression to severe hypersensitivity can be rapid and potentially fatal[28][22]. Re-challenge with dolutegravir after a hypersensitivity reaction is contraindicated due to risk of more severe reactions[28][22].

Pregnancy and Reproductive Health Concerns

Initial concerns about neural tube defects in infants exposed to dolutegravir during early pregnancy have been clarified through extended follow-up studies. Updated evidence from Botswana surveillance shows a smaller increased risk than initially reported, with approximately two extra cases of neural tube defects per 1,000 women exposed to dolutegravir at conception or during early pregnancy compared to other antiretroviral drugs[29][30]. Current recommendations allow dolutegravir use in women of childbearing potential with appropriate counseling about risks and benefits[30].

The World Health Organization has updated its guidance to state that dolutegravir should be available for all women, including those of childbearing age, due to the overwhelming benefits compared to the small increased risk[29][30]. However, healthcare providers must counsel women about the potential risk and discuss benefits versus risks if pregnancy is planned or confirmed during treatment[30]. Effective contraception should be discussed, and decisions about continuing dolutegravir during pregnancy should consider gestational age and the critical period for neural tube defect development[30].

Conclusion

Dolutegravir presents a complex risk-benefit profile that extends significantly beyond the favorable safety data from controlled clinical trials. The drug's ability to disrupt blood-brain barrier integrity through endoplasmic reticulum stress pathways represents a unique mechanism of toxicity that may contribute to the high rates of neuropsychiatric adverse events observed in clinical practice. While these effects are generally reversible, they occur in a substantial proportion of patients and can significantly impact quality of life and treatment adherence.

The renal effects of dolutegravir, while not representing true nephrotoxicity, create important clinical challenges in monitoring kidney function and may complicate care in patients with pre-existing renal disease. Hepatic effects show particular concern in elderly populations, requiring enhanced monitoring in this vulnerable group. Despite generally favorable lipid profiles, significant weight gain associated with dolutegravir use may have long-term metabolic consequences that require careful monitoring and intervention.

Healthcare providers should implement comprehensive monitoring strategies that include regular assessment of neuropsychiatric symptoms, appropriate interpretation of creatinine elevations, liver function monitoring especially in elderly patients, and weight management counseling. The higher rates of adverse events observed in real-world practice compared to clinical trials emphasize the importance of individualized risk assessment and close patient follow-up when prescribing dolutegravir-based regimens.

Sources

[1] Antiretroviral drugs efavirenz, dolutegravir and bictegravir ... https://pmc.ncbi.nlm.nih.gov/articles/PMC10030948/

[2] Dolutegravir Disrupts Mouse Blood-Brain Barrier by Inducing ... https://sciety.org/articles/activity/10.21203/rs.3.rs-4420818/v1

[3] Dolutegravir induces endoplasmic reticulum stress at the blood ... https://pubmed.ncbi.nlm.nih.gov/39985305/

[4] Postmortem Analysis of Dolutegravir, Tenofovir, Lamivudine, and ... https://pubmed.ncbi.nlm.nih.gov/38900910/

[5] Postmortem Analysis of Dolutegravir, Tenofovir, Lamivudine, and ... https://academic.oup.com/jid/article/230/5/1215/7696670

[6] A Study of the Pharmacokinetics and Antiviral Activity of Dolutegravir ... https://pmc.ncbi.nlm.nih.gov/articles/PMC4166983/

[7] A Study of the Pharmacokinetics and Antiviral Activity of Dolutegravir ... https://www.natap.org/2014/HIV/062314_01.htm

[8] Dolutegravir Cerebrospinal Fluid Diffusion in HIV-1–Infected ... https://academic.oup.com/ofid/article/6/6/ofz174/5510470

[9] Dolutegravir Cerebrospinal Fluid Diffusion in HIV-1–Infected ... https://pmc.ncbi.nlm.nih.gov/articles/PMC6546201/

[10] Neuropsychiatric Adverse Events with Dolutegravir and ... - PubMed https://pubmed.ncbi.nlm.nih.gov/30899113/

[11] [PDF] Neuropsychiatric Adverse Events with Dolutegravir and Other ... https://www.natap.org/2023/HIV/aids_21_1_04-10.pdf

[12] Prevalence of neuropsychiatric adverse events and associated ... https://pubmed.ncbi.nlm.nih.gov/36336827/

[13] Dolutegravir Side Effects: Common, Severe, Long Term - Drugs.com https://www.drugs.com/sfx/dolutegravir-side-effects.html

[14] Neuropsychiatric adverse effects of dolutegravir in real-life clinical ... https://www.elsevier.es/en-revista-enfermedades-infecciosas-microbiologia-clinica-english-428-articulo-neuropsychiatric-adverse-effects-dolutegravir-in-S2529993X20302355

[15] Dolutegravir and central nervous system side-effects: abacavir, older ... https://www.aidsmap.com/news/oct-2016/dolutegravir-and-central-nervous-system-side-effects-abacavir-older-age-increase-risk

[16] Older Age is Associated with Higher Dolutegravir Exposure in ... https://europepmc.org/article/med/32737820

[17] Dolutegravir and Risk of Neuropsychiatric Adverse Events https://academic.oup.com/jid/advance-article/doi/10.1093/infdis/jiaf098/8042716

[18] Serum creatinine elevation after switch to dolutegravir in a human ... https://pmc.ncbi.nlm.nih.gov/articles/PMC5525135/

[19] Comparison of Renal Function Biomarkers of Serum Creatinine and ... https://pmc.ncbi.nlm.nih.gov/articles/PMC9005235/

[20] Dolutegravir – a review of the pharmacology, efficacy, and safety in ... https://pmc.ncbi.nlm.nih.gov/articles/PMC4500604/

[21] [PDF] Elderly Patients on Antiretroviral Therapy with Dolutegravir are at ... https://www.natap.org/2018/IAC/10199.pdf

[22] Risks & Side Effects of DOVATO (dolutegravir/lamivudine) https://www.dovato.com/dovato-side-effects/

[23] Dolutegravir and lamivudine (oral route) - Side effects & dosage https://www.mayoclinic.org/drugs-supplements/dolutegravir-and-lamivudine-oral-route/description/drg-20461310

[24] Lipid profiles of people with human immunodeficiency virus with ... https://journals.aboutscience.eu/index.php/dti/article/view/2529

[25] Comparative changes of lipid levels in treatment-naive, HIV-1 ... https://pubmed.ncbi.nlm.nih.gov/25637061/

[26] Switch to dolutegravir raises the risk of potentially harmful weight ... https://www.aidsmap.com/news/jul-2020/switch-dolutegravir-raises-risk-potentially-harmful-weight-gain-four-country-african

[27] A review of dolutegravir use and weight gain in a diverse HIV cohort ... https://bhiva.org/wp-content/uploads/2024/10/P064.pdf

[28] dolutegravir (Tivicay, Tivicay PD) https://www.iapac.org/fact-sheet/dolutegravir-tivicay-tivicay-pd/

[29] Dolutegravir safety in pregnancy: risk is lower than first reported https://www.aidsmap.com/news/jul-2019/dolutegravir-safety-pregnancy-risk-lower-first-reported

[30] updated advice on increased risk of neural tube defects - GOV.UK https://www.gov.uk/drug-safety-update/dolutegravir-tivicay-triumeq-juluca-updated-advice-on-increased-risk-of-neural-tube-defects

[31] Dolutegravir/Lamivudine Efficacy and Safety Outcomes in People ... https://academic.oup.com/ofid/article/11/7/ofae365/7702398

[32] Dolutegravir (oral route) - Side effects & dosage - Mayo Clinic https://www.mayoclinic.org/drugs-supplements/dolutegravir-oral-route/description/drg-20061287

[33] Efficacy and Safety Outcomes in Adults Initiating Dolutegravir ... https://academic.oup.com/ofid/article/12/3/ofaf135/8059175

[34] Clinical Profile and Adverse Effects of Dolutegravir Treatment in HIV ... https://pmc.ncbi.nlm.nih.gov/articles/PMC11253573/

[35] Safety and pharmacokinetics of dolutegravir in pregnant mothers ... https://journals.plos.org/plosmedicine/article?id=10.1371%2Fjournal.pmed.1002895

[36] Dolutegravir - Aidsmap https://www.aidsmap.com/about-hiv/arv-factsheet/dolutegravir

[37] Comparative efficacy, tolerability and safety of dolutegravir and ... https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(20)30317-5/fulltext

[38] Dolutegravir | Drugs - BNF - NICE https://bnf.nice.org.uk/drugs/dolutegravir/

[39] Effectiveness and safety of dolutegravir two‐drug regimens in ... https://pmc.ncbi.nlm.nih.gov/articles/PMC8248313/

[40] Dolutegravir (TIVICAY) Tablets: Uses & Side Effects - Cleveland Clinic https://my.clevelandclinic.org/health/drugs/20972-dolutegravir-oral-tablet

[41] Metabolic implications and safety of dolutegravir use in pregnancy https://www.sciencedirect.com/science/article/abs/pii/S2352301823001418

[42] Rilpivirine Dolutegravir Tablets: Uses & Side Effects - Cleveland Clinic https://my.clevelandclinic.org/health/drugs/20425-dolutegravir-rilpivirine-oral-tablets

[43] Cognitive performance, neuropsychiatric symptoms, and ... https://www.thelancet.com/journals/lanhiv/article/PIIS2352-3018(24)00209-1/fulltext

[44] Antiretroviral drugs efavirenz, dolutegravir and bictegravir ... - Frontiers https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2023.1118580/full

[45] Varying dolutegravir distribution across the body may affect the ... https://www.aidsmap.com/news/mar-2024/varying-dolutegravir-distribution-across-body-may-affect-drugs-ability-suppress-hiv

[46] Postmortem Analysis of Dolutegravir, Tenofovir, Lamivudine, and ... https://academic.oup.com/jid/article-abstract/230/5/1215/7696670

[47] Cerebral function parameters in people with HIV switching integrase ... https://www.tandfonline.com/doi/full/10.1080/25787489.2021.1997880

[48] Abacavir/Dolutegravir/Lamivudine (Triumeq)–Induced Liver Toxicity ... https://pmc.ncbi.nlm.nih.gov/articles/PMC5522577/

[49] Weight gain on dolutegravir: Association is not the same as causation https://pmc.ncbi.nlm.nih.gov/articles/PMC10244923/

[50] 899. Use of Dolutegravir/Rilpivirine in Treatment of HIV in PLWH ... https://academic.oup.com/ofid/article/8/Supplement_1/S540/6450445

[51] Lipid profiles of people with human immunodeficiency virus with ... https://pmc.ncbi.nlm.nih.gov/articles/PMC10158613/

[52] Chronic Liver Enzyme Elevation and Use of Contemporary ARVs ... https://academic.oup.com/ofid/article/11/6/ofae308/7689795

[53] Weight Gain After HIV Therapy Initiation - Oxford Academic https://academic.oup.com/jcem/article/109/2/e478/7223438

[54] Determinants of early change in serum creatinine after initiation of ... https://bpspubs.onlinelibrary.wiley.com/doi/10.1111/bcp.16009

[55] Dolutegravir increases Peritoenal fat of adult HIV patients but not ... https://www.endocrine-abstracts.org/ea/0077/ea0077lb32

[56] [PDF] Presumed Severe Hepatocellular Toxicity after Initiation on a ... https://www.anncaserep.com/open-access/presumed-severe-hepatocellular-toxicity-after-initiation-on-a-dolutegravir-based-hiv-8383.pdf

[57] Change in body weight and risk of hypertension after switching from ... https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(23)00013-5/fulltext

[58] Acute interstitial nephritis due to dolutegravir: The first case reported https://www.sciencedirect.com/science/article/pii/S0211699521002162

[59] Switch from boosted protease inhibitor to dolutegravir reduces lipids ... https://www.aidsmap.com/news/aug-2017/switch-boosted-protease-inhibitor-dolutegravir-reduces-lipids-people-hiv-higher-risk

[60] Dolutegravir - LiverTox - NCBI Bookshelf https://www.ncbi.nlm.nih.gov/books/NBK548350/

[61] Effect of Dolutegravir on Plasma Glucose Among Human ... https://pmc.ncbi.nlm.nih.gov/articles/PMC9586418/

[62] Lipid profile changes associated with antiretroviral therapies in a ... https://www.elsevier.es/es-revista-farmacia-hospitalaria-121-articulo-lipid-profile-changes-associated-with-S1130634323000430

[63] The risk of hyperglycemia associated with use of dolutegravir among ... https://pmc.ncbi.nlm.nih.gov/articles/PMC9691558/

[64] Dolutegravir and raltegravir cause changes to fat cells - Aidsmap https://www.aidsmap.com/news/nov-2019/dolutegravir-and-raltegravir-cause-changes-fat-cells

[65] Dolutegravir-related hyperglycemia among children and adolescents https://www.medrxiv.org/content/10.1101/2023.12.05.23299497v1

[66] Weight Gain and Integrase Inhibitors - PMC - PubMed Central https://pmc.ncbi.nlm.nih.gov/articles/PMC7433018/

[67] Prevalence and factors associated with hyperglycemia among ... https://journals.sagepub.com/doi/10.1177/20499361241272630

[68] Excess Weight Gain With Integrase Inhibitors and Tenofovir ... https://academic.oup.com/ofid/article/8/12/ofab542/6430220

[69] Effect of dolutegravir-based antiretroviral therapy on glycemic ... https://www.nature.com/articles/s41598-025-02130-8

[70] [PDF] Lipid Profile Improvement after Switching to Dolutegravir-Based ... http://www.jmatonline.com/PDF/1021-1025-PB-01101.pdf

[71] A review of dolutegravir-associated weight gain and secondary ... https://journals.sagepub.com/doi/10.1177/20503121241260613

[72] Evaluating the Glycemic Effects of Dolutegravir and Its Predictors ... https://academic.oup.com/ofid/article/11/10/ofae596/7815813

[73] Effect of dolutegravir on weight changes and lipid profile compared ... https://www.sciencedirect.com/science/article/pii/S1876034124003642

[74] Effect of dolutegravir-based first-line antiretroviral therapy on weight ... https://www.tandfonline.com/doi/full/10.1080/07853890.2023.2242250

[75] Hyperglycemia and its associated factors among people living with ... https://journals.sagepub.com/doi/10.1177/20499361251332031