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Microbes & Immunity Oxidative toxicity and folate in HIV on DTG-ART

folate status among PLWH. While the findings are clinically in aggregate. No identifiable information was included;
significant, they must be interpreted with caution, given therefore, additional consent was not required under the
methodological limitations, including reliance on plasma approved study protocol.
folate alone, the use of the TBARS assay for MDA, and
unmeasured confounding factors such as diet, lifestyle, Availability of data
and concomitant medications. Importantly, the observed Data supporting the findings of this study are available
changes likely reflect the combined influence of DTG, from the corresponding author on reasonable request.
companion drugs (TDF/3TC), and underlying HIV-
related inflammation rather than DTG alone. Nevertheless, References
the results highlight the need for routine monitoring of 1. Mwebaza J, Meya D, Musiime V, Birungi C. Prevalence of
folate and oxidative stress biomarkers in patients on ART neuropsychiatric adverse events and associated factors
and suggest a potential role for targeted supplementation among adult patients on dolutegravir attending Mulago ISS
strategies. Future research incorporating longitudinal clinic. HIV Med. 2023;24(4):491-501.
designs, functional folate markers, more specific assays, doi: 10.1111/hiv.13428
and cost-effectiveness analyses will be essential to validate
and extend these findings, particularly in vulnerable 2. Tesfaye E, Demelash K. Burden of care among caregivers of
groups such as pregnant women. patients with mental illness in Ethiopia: A systematic review
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Acknowledgments doi: 10.1186/s12889-025-23461-1
The authors would like to acknowledge laboratory directors 3. Rossetti B, Ferrara M, Taramasso L, et al. Evolution of
of BIOQUEST and Praise Worth Laboratories, Enugu State, self-reported neuropsychiatric symptoms after switching
Nigeria, for providing the folate and malondialdehyde from dolutegravir/abacavir/lamivudine to bictegravir/
assays. emtricitabine/tenofovir alafenamide: Results from
the randomized DOBINeuro trial. Infect Dis Ther.
Funding 2025;14(1):293-304.
None. doi: 10.1007/s40121-024-01083-1
4. Cabrera RM, Souder JP, Steele JW, et al. The antagonism
Conflict of interest of folate receptor by dolutegravir: Developmental
The authors declare no conflicts of interest. toxicity reduction by supplemental folic acid. AIDS.
2019;33(11):1789-1798.
Author contributions 5. Gilmore JC, Hoque MT, Dai W, et al. Interaction between

Conceptualization: All authors dolutegravir and folate transporters and receptor in human
Investigation: Onwuka Kalu Chima and rodent placenta. EBioMedicine. 2022;75:103771.
Methodology: All authors doi: 10.1016/j.ebiom.2021.103771
Writing–original draft: Onwuka Kalu Chima 6. Tukeman GL, Wei H, Lin YL, Wlodarczyk BJ, Finnell RH,
Writing–review & editing: All authors Cabrera RM. Dolutegravir-induced neural tube defects in
mice are folate responsive. AIDS. 2024;38(4):439-446.
Ethics approval and consent to participate
doi: 10.1097/QAD.0000000000003639
Ethical approval for the study was obtained from the Health 7. Chandiwana NC, Chersich M, Venter WDF, et al. Unexpected
Research Ethics Committee of the University of Nigeria interactions between dolutegravir and folate: Randomized
Teaching Hospital (NHREC/05/01/2008B-FWA00002458- trial evidence from South Africa. AIDS. 2021;35(2):205-211.
1RB00002323). All procedures were conducted in
accordance with the principles of the Declaration of doi: 10.1097/QAD.0000000000002741
Helsinki. Written informed consent was obtained from all 8. Zhou Q, Dong G, Wang Q, et al. Preconception folic acid
participants before enrolment. Confidentiality and data supplementation for the prevention of birth defects:
protection were maintained through data anonymization A prospective, population-based cohort study in mainland
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Consent for publication
9. Zash R, Holmes L, Diseko M, et al. Neural-tube defects and
Specific consent for publication of participant data was not antiretroviral treatment regimens in Botswana. N Engl J
obtained because all data were anonymized and analyzed Med. 2019;381(9):827-840.

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