From Struggle to Stability

Abstract Dolutegravir-based antiretroviral therapy is valued for its potent efficacy, high-resistance barrier, and overall tolerability. However, postmarketing surveillance has revealed a higher incidence of neuropsychiatric adverse events (NPAEs) than initially reported in clinical trials. We report 2 cases of newly diagnosed individuals with HIV who developed neuropsychiatric symptoms, including depression, anxiety, insomnia, fatigue, and suicidal ideation, within weeks of initiating dolutegravir/lamivudine, despite no prior psychiatric history. These symptoms significantly affected their quality of life and led to repeated medical consultations. Both patients were switched to a regimen comprising bictegravir, emtricitabine, and tenofovir alafenamide after conservative measures failed. Following the switch, physical symptoms resolved rapidly, and neuropsychiatric complaints improved progressively. Within 1 to 3 months, both individuals regained emotional stability and full functional recovery. These cases highlight the potential for clinically relevant NPAEs with dolutegravir in select patients. Switching to bictegravir-based regimens may offer symptomatic relief while maintaining virologic suppression. Clinicians should monitor for neuropsychiatric symptoms during integrase inhibitor therapy and consider timely therapeutic adjustments. Further studies are needed to elucidate underlying mechanisms and risk factors.