Background: Dolutegravir (DTG) is recommended by the WHO as a first‑line antiretroviral. While its efficacy and tolerability are well established, hepatotoxicity concerns persist due to inconsistent findings, underscoring the need for a comprehensive synthesis of global data. Methods: We performed a systematic narrative review analyzing 19 eligible studies (2015-2025) from PubMed, Mendeley, Cochrane, and Google Scholar using keywords related to dolutegravir and hepatotoxicity alongside comparator antiretroviral agents. Inclusion criteria encompassed adult and pregnant populations with reported hepatic outcomes, while exclusions applied to low‑quality studies, non‑English publications, and participants under 15 years. Bias was assessed using the Newcastle‑Ottawa scale, with one randomized trial showing low bias and most observational studies demonstrating moderate bias. Results: Across cohorts, DTG therapy was associated with hepatotoxicity in 20–30% of patients. Comparative analyses often favored DTG, with lower rates of liver enzyme abnormalities than efavirenz and reduced bilirubin compared to protease inhibitors. Predictors of hepatotoxicity included prior ART exposure and elevated baseline liver enzymes. Conclusion: Dolutegravir demonstrates an acceptable hepatic safety profile, comparing favorably with other antiretroviral regimens. These findings support its continued role as a WHO‑endorsed first‑line therapy. Further randomized studies are warranted to refine risk estimates and guide monitoring strategies.