Alteration in Gut Microbiome and Intestinal Barrier Function caused by Efavirenz versus Dolutegravir Treatments in Mice

Dolutegravir (DTG) is replacing efavirenz (EFV) as first-line antiretroviral therapy because of its better tolerance. However, DTG cause similar, but milder, gastrointestinal and neurological side effects as EFV does. We speculated that impaired gut barrier function contributes to their side effects. For this purpose, the mice were intragastrically administered EFV, DTG, or vehicle for 60 consecutive days. The plasma levels of FITC-dextran were determined to evaluate gut barrier integrity. Colonic contents were collected for 16S rRNA sequencing. Adipose, liver, ileum, and colon tissues were collected for pathological examination, and intestinal zona occludens-1 (ZO-1) immunofluorescence staining and goblet cell staining were performed. We found that EFV significantly retarded body weight gain, decreased glucose uptake, and caused lipodystrophy and hepatocyte necrosis. EFV also decreased species richness of gut microbiota, increased Verrucomicrobia and Proteobacteria, and decreased Patescibacteria and Cyanobacteria. Moreover, it caused crypt damage, goblet cell loss, reduced ZO-1 expression, impaired gut barrier function, and suppressed expressions of Pdha1 and Ndufv1. Interestingly, DTG impaired barrier function similar to EFV, but the impairment was milder. DTC also inhibited MPC1, MPC2, and Pdha1 expression. Our results suggest a link between abnormal energy metabolism, impaired gut barrier integrity and side effects of EFV and DTG.