Dolutegravir and Hepatotoxicity

Comparison with Other Antiretrovirals

Dolutegravir has a better hepatic safety profile compared to nevirapine, which is strongly contraindicated in patients with liver function derangement, according to the American College of Clinical Pharmacology 1
Nevirapine has been associated with a 12.5% incidence of hepatotoxicity, with clinical hepatitis diagnosed in 1.1% of patients, and can progress to fulminant liver failure and death, as reported by the National Institutes of Health 1
Integrase inhibitors like dolutegravir are generally considered safer from a hepatotoxicity perspective compared to non-nucleoside reverse transcriptase inhibitors (NNRTIs) and protease inhibitors (PIs), as stated by the British Pharmacological Society 2, 1

Dolutegravir can cause isolated creatinine elevations through inhibition of renal tubular secretion, but this is not a toxicity, according to the American Thoracic Society 3