Abstract
Background: Dolutegravir (DTG), an integrase strand transfer inhibitor, is increasingly adopted as the preferred first-line antiretroviral therapy (ART) due to its potent virological efficacy and high barrier to resistance. However, emerging safety concerns—such as reports of neural tube defects, neuropsychiatric symptoms, and hematological abnormalities including sideroblastic anemia—have raised important questions regarding its long-term safety profile.
Objective: This study assessed the impact of initiating DTG-based ART on hematological parameters—including red blood cell indices, white blood cell differentials, and platelet indices—among treatment-naïve HIV-positive individuals.
Methods: A total of 40 treatment-naïve HIV-positive adults (19 males, 21 females) without co-morbidities were prospectively recruited from the Antiretroviral Therapy Clinic of the University of Nigeria Teaching Hospital (UNTH), Enugu, between January 2023 and July 2024. Forty age- and sex-matched HIV-seronegative individuals served as controls. Baseline socio-demographics were collected using a structured questionnaire. Blood samples were obtained at baseline and after six months of DTG-based ART initiation. Complete blood count (CBC) was assessed using an automated hematology analyzer.
Results: After six months of DTG-based ART, statistically significant hematological changes were observed. These included increases in red blood cell count (4.78±0.49×10¹²/L), hemoglobin concentration (13.82±1.55 g/dL), hematocrit level (40.61±3.91%), mean corpuscular volume (82.22±4.84 fL), mean corpuscular hemoglobin (26.27±1.97 pg), and neutrophil count (51.53±8.94%). Conversely, a decrease in lymphocyte count (35.47±7.81%) was noted. No significant changes were observed in mean corpuscular hemoglobin concentration (MCHC), red cell distribution width–coefficient of variation (RDW-CV), or red cell distribution width–standard deviation (RDW-SD).
Conclusion: DTG-based ART was associated with significant changes in several hematological indices and anthropometric parameters after six months of treatment. These findings underscore the importance of continued hematologic monitoring and long-term safety assessment in patients receiving DTG-containing regimens.
Keywords
Hematology, Dolutegravir, Red cell indices, Platelet indices, White blood cells count, HIV, Antiretroviral therapy (ART), Sub-Saharan Africa