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Microbes & Immunity

ORIGINAL RESEARCH ARTICLE
Assessment of oxidative toxicity and folate

status in HIV patients on dolutegravir-based
antiretroviral therapy

Onwuka Kalu Chima* and Ejike Felix Chukwurah

Department of Medical Laboratory Science/Haematology and Blood Transfusion, Faculty of Health
Sciences and Technology, Ebonyi State University, Abakaliki, Ebonyi State, Nigeria

Abstract

Dolutegravir (DTG), a key component of antiretroviral therapy (ART), has demonstrated
potent virologic suppression and superior efficacy compared to standard regimens
in HIV management. However, concerns about its long-term safety persist, with
emerging evidence suggesting potential adverse effects. Notably, studies have
reported an increased risk of neural tube defects in infants born to women
exposed to DTG during pregnancy, as well as associations with neuropsychiatric
effects and sideroblastic anemia. This cross-sectional study investigated plasma
folate and malondialdehyde (MDA) levels—markers of antioxidant status and
oxidative stress, respectively—in HIV-positive patients receiving DTG-based ART
at the University of Nigeria Teaching Hospital, Enugu. A total of 120 participants
were recruited, comprising 40 treatment-naïve patients initiating DTG-based ART,
*Corresponding author:
Onwuka Kalu Chima 40 patients on DTG-based ART for 6 months, and 40 HIV-negative controls. Plasma
(chimaonwuka@unth.edu.ng) folate was measured using chemiluminescence immunoassay, while MDA levels
Citation: Chima OK, were determined spectrophotometrically. Results showed significantly elevated
Chukwurah EF. Assessment of MDA levels in both treatment-naïve (5.72 ± 3.61 µmol/L) and 6-month DTG-treated
oxidative toxicity and folate status in patients (8.94 ± 5.03 µmol/L) compared to controls (1.19 ± 0.18 µmol/L). Conversely,
HIV patients on dolutegravir-based
antiretroviral therapy. Microbes & folate concentrations were markedly lower in the DTG groups (2.23 ± 1.52 and 1.89
Immunity. 2025;2(4):122-131. ± 0.54 ng/mL, respectively) than in controls (11.11 ± 1.31 ng/mL). These findings
doi: 10.36922/MI025310074 suggest that DTG-based ART may elevate oxidative stress while reducing antioxidant
Received: August 01, 2025 levels, underscoring the need for careful monitoring of its biochemical effects in HIV-
positive individuals.
Revised: August 27, 2025
Accepted: September 10, 2025
Keywords: Dolutegravir; Oxidative toxicity; Folate status; Antiretroviral therapy; HIV
Published online: October 10,
2025
Copyright: © 2025 Author(s).
This is an Open-Access article 1. Introduction
distributed under the terms of the
Creative Commons Attribution Dolutegravir (DTG), an integrase strand transfer inhibitor, has become a cornerstone
License, permitting distribution,
and reproduction in any medium, of modern antiretroviral therapy (ART) owing to its potent virologic suppression, high
provided the original work is genetic barrier to resistance, and favorable safety and efficacy profile across diverse
properly cited. populations. Its widespread adoption as part of first-line ART regimens has contributed
Publisher’s Note: AccScience significantly to global progress toward HIV epidemic control. Despite these clinical
Publishing remains neutral with successes, concerns regarding the long-term safety of DTG have emerged, particularly
regard to jurisdictional claims in
published maps and institutional in relation to neuropsychiatric adverse events (NPAEs), hematological alterations,
affiliations. teratogenicity through interference with folate metabolism, and potential contributions

Volume 2 Issue 4 (2025) 122 doi: 10.36922/MI025310074