Dolutegravir functions by interposing with an enzyme necessitated by HIV called integrase. Using Dolutegravir as section of combination therapy downgrades HIV’s capability to infect cells and create copies of itself. Dolutegravir is an INSTI that functions by suppressing the interjection of HIV deoxyribonucleic acid (DNA) into host cells, thereby obviating subsequent viral duplication. It fits loosely into the attaching pocket of the intasome and undergoes conformational revamps in the pocket structure while retaining its attaching capability 5.

Dolutegravir has favorable PK properties and remains PC well above the protein-adjusted 90% inhibitory accumulation for HIV-1 6.

Dolutegravir is hastily absorbed pursuing per os administration. The median maximum plasma concentration is reached 1.5–2.5 hours after per os intake with a mean t1/₂ of 12–15 hours, delivering reasonable for quotidian dosing without seek for pharmacological boosting. Bioavailability diversifies with lipid rich foods 7.

Dolutegravir has got great attraction for plasma proteins, and .99% of dolutegravir is attached to plasma proteins, and it is depending of the plasma concentration. Dolutegravir has best discernment to distinctive body compartments and occurs to cross the BBB 8.

Dolutegravir is extendedly metabolized in the liver using the phase II metabolism initially through glucuronidation via uridine diphosphate glucuronosyltransferase (UGT) 1A1, while a least pathway (in Phase I) encloses cytochrome P (CYP450) 3A4 with other minor pathways (phase II) enclosing UGT1A3 and glucuronosyltransferase (GT) 1A9 9.

The ultimate t1/₂ is around 14 hours. The apparent oral clearance is near to 1 liter/hour. 53% of the daily dose of dolutegravir is excreted unchanged in the feces, thirty two percent through urine as glucuronide (eighteen percent) or alkylated product (three point five percent), and disparate organic conjugated products sequencing from phase II liver metabolisms. Around 1% of unchanged dolutegravir is excreted through urine, delivering it comparatively secure to use in mild or moderate renal problems 9.

DTG security in pregnant women is not understood. Thereupon, the manufacturer recommends that dolutegravir should solely be used in pregnancy if “the implicit merit justifies the potential peril.” 10. Dolutegravir’s categorized as pregnancy category B (no confirmation of pitfall in humans) means either animal-reproduction inquests have not substantiated a fetal peril but there are no restrained inquests in pregnant women or animal-reproduction inquests have reveal a side effect (distinctive than a de-escalate in fertility) that was not inveterate in restrained inquests in women in the 1^st trimester (and there is no confirmation of a pitfall in later trimesters) or there is survey in animal that revealed the medication is safe in pregnant animal, but there is no fetal pitfall confirmation in pregnant women 11.Information on DTG safety in women who started ART before pregnancy is limited and further studies are still needed, and some study written up beneath revealed: Tsepamo Study (Botswana) displayed that since August 2014 the Tsepamo Study has performed ongoing birth surveillance to evaluate the safety of ART in pregnancy. Recent analysis compared women who started either TDF/FTC/EFV (4593 rendered from August 2014 to August 2016) or TDF/FTC + DTG (845 delivered from November 2016 to April 2017) during pregnancy. The analysis found no significant differences in: total and severe adverse birth outcomes, preterm, very preterm birth, small for gestational age, very small for gestational age, stillbirth, and neonatal death. Adjusted risk ratios (aRR) for DTG-based regimens with EFV-based regimens as reference were respectively (for the above outcomes): aRR 1.0 (95% CI: 0.9–1.1); aRR 1.0 (95% CI: 0.8–1.2); aRR 1.0 (95% CI: 0.8–1.1); aRR 1.2 (95% CI: 0.8–1.7); aRR 1.0 (95% CI: 0.9–1.2); aRR 0.9 (95% CI: 0.7–1.2); aRR 0.9 (95% CI: 0.6–1.5); and aRR 1.0 (95% CI: 0.5– 1.9). Information on pregnancy safety in women with preconception exposure to DTG is still limited 12. Antiviral Pregnancy Registry (APR) revealed that as of January 2017, pregnancy outcomes and birth defects were analyzed from 142 pregnancies with reported exposure to DTG during pregnancy. There were 128 live births reported (3 terminations, 11 miscarriages, no stillbirths). Only 4 (3.0%) reported birth defects, which is similar to the expected rate of birth defects in the general population 13. European Pregnancy and Paediatric HIV Cohort Collaboration (EPPIC) displayed that as of July 2017, 101 pregnancies with exposure to DTG had been identified with 84 birth outcomes. Rates of preterm delivery and “small for gestational age” were identical to outcomes reported from women on alternative regimens (standard of care in the United Kingdom of Great Britain and Northern Ireland) 14. In July 2019, WHO declared that dolutegravir is secure for women of child-bearing age. Therefore, TLD is currently the preferred 1^st-line and second-line standard for entire populations, involving pregnant women and those of childbearing age 1516.