Comparison Of Clinical Stadium Changes And Immunologic Parameter Of Adult HIV patients With Dolutegravir And Efavirenz Based Antiretroviral Therapy

<ns3:p> Background Human immunodeficiency virus (HIV) remains a major global health challenge. Dolutegravir-based antiretroviral therapy (ART) is recommended as the preferred first-line regimen due to its high efficacy and tolerability. However, real-world evidence comparing clinical and immunologic outcomes between dolutegravir- and efavirenz-based therapies is limited in Indonesia. This study compared changes in clinical stage and immunologic parameters among adult HIV patients receiving these regimens. Methods This observational analytic study used a retrospective cohort design. Data were collected from medical records of adult HIV patients at Dr. Wahidin Sudirohusodo Hospital (Makassar, Indonesia) from January 2020 to December 2025. Included patients were aged ≥18 years, received dolutegravir- or efavirenz-based therapy for ≥12 months, and had complete baseline, month 6, and month 12 data on WHO clinical stage and CD4 T-cell counts. Analyses used chi-square tests (p < 0.05 significance). Results Of 175 patients, most were male (76.6%) and aged <50 years (89.7%). At baseline, all had CD4 counts <200 cells/mm <ns3:sup>3</ns3:sup> ; 73.1% were WHO stage III–IV. No baseline clinical stage difference existed between groups (OR 1.64; 95% CI 0.78–3.42; p = 0.12). By month 12, 77.1% achieved clinical stages I–II in both groups. Immunologic recovery occurred in 72.6% (CD4 ≥ 200 cells/mm <ns3:sup>3</ns3:sup> ), with dolutegravir patients showing higher CD4 recovery (OR 2.12; 95% CI 1.06–4.25; p = 0.02). Conclusions Both regimens improved clinical and immunologic outcomes over 12 months, but dolutegravir-based ART was associated with superior CD4 recovery. Early diagnosis and timely ART initiation are essential for optimizing HIV outcomes. </ns3:p>