A REVIEW ON A MIRACLE DRUG “DOLUTEGRAVIR” IN A RURAL TERTIARY HOSPITAL

Background: Antiretroviral therapy (ART) has fundamentally changed human immunodeficiency virus (HIV) infection from a fatal diagnosis to a manageable chronic illness. The integration of second-generation integrase strand transfer inhibitors (INSTIs), specifically Dolutegravir (DTG), has redefined frontline regimens due to rapid virological suppression and an exceptionally high genetic barrier to resistance. Objective: This review evaluates the clinical efficacy, safety profile, and real-world outcomes of Dolutegravir-based regimens within a rural tertiary care hospital setting in Andhra Pradesh, India. Methods: Visual telemetry data and patient clinical markers (CD4+ T-lymphocyte counts and HIV viral load) were analyzed longitudinally from an institutional antiretroviral therapy center registry. The standard of care evaluated was the fixed-dose combination of Tenofovir, Lamivudine, and Dolutegravir (TLD). Results: Institutional registry records show 2,556 cumulative registrations. Real-world observations demonstrated that even with suboptimal adherence (~80%), a high proportion of patients achieved a status of target not detected (TND). In HIV-1 cohorts, the initiation of DTG correlated with precipitous drops in viral copy numbers to zero, alongside stable immune reconstitution manifested by elevated CD4 counts. HIV-2 cohorts maintained long-term immunological stability. Minor adverse events included anemia, joint pains, and symptoms of osteoporosis. Opportunistic infections such as Toxoplasmosis and Pneumocystis pneumonia (PCP) were rare, though extra-pulmonary tuberculosis (TB) remains a notable clinical co-morbidity. Conclusion: Dolutegravir-based first-line therapy yields highly robust clinical and immunological outcomes in rural populations. Early diagnostic strategies, combined with persistent therapeutic monitoring every six to twelve months, remain essential to meeting global UNAIDS 95-95-95 suppression benchmarks.

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