Background: In combination with other two anti retroviral drugs,Efavirenz(EFV) was the treatment of choice for human immuno deficiency virus(HIV) infection.Given concern sabout safety and resistance,dolutegravir(DTG)-based regimen have been considered as preferred first-line treatments for both treatment naive and treatment experienced HIV patents.rnObjective:To determine the safety and survival rate of DTG compared with EFV-based anti retro viral therapies as first-line HIV treatment among HIV patients.rnObjective: To determine the safety and survival rate of DTG compared with EFV-basedrnantiretroviral therapies as first-line HIV treatment among HIV patients.rnMethods: A retrospective hospital-based cohort study carried out from September 1, 2019rnto August 30, 2020 at HIV clinics of three selected hospitals with HIV treatment centers inrnAmhara region, Ethiopia. All HIV patients â‰¥3 years old, those had been either on DTG orrnEFV-based combination anti-retroviral therapy (cART), and had detectable VL werernincluded. All HIV patients who fulfill inclusion criteria were studied. Data was extractedrnfrom patient chart using structure questionnaire. Descriptive statistics, chi-square test,rnunivariate and multivariate cox-regression were performed for data analysis. A statisticalrnsignificance was considered at p-value â‰¤ 0.05.rnResult: Overall, 990 HIV patients were included in the analysis of which 694 took DTGrnand 296 received EFV based-regimen. A viral load of < 50 copies/mL was observed in 479rnof 694 participants (69%) in the DTG group and 196 of 296 participants (66%) in the EFVrngroup (AHR=1.28, 95%CI: 1.08-1.51; p=0.004).Among patients with a baseline viral loadrnof â‰¥1000 copies/ mL, a total of 66 from 174 participants (38.0%) in the DTG group and 35rnout of 96 participants (36.5%) in the EFV group had a viral load of