HIV protease inhibition: limited recent progress and advances in understanding current pitfalls

Curr Top Med Chem. 2004;4(9):991-1007. doi: 10.2174/1568026043388529.

Abstract

The identification of HIV-1 protease (HIVp) as a target for therapeutic intervention against AIDS was soon followed by major efforts to understand its substrate specificity, reaction kinetics and three-dimensional structure, both in the free state and in complex with a number of ligands including substrate mimics, products, and inhibitors. On the whole these studies have been extremely successful and have had a major impact on our understanding of ligand-receptor interactions and enzyme inhibition mechanisms. HIVp has also become a paradigm for the development and testing of new drug-design methodologies both in vitro and in silico. Even though thousands of potential HIVp inhibitors exhibiting amazing chemical diversity have been synthesized or identified from natural sources, only a few have turned out to be useful for human therapy. Although the alternative goal of preventing enzyme dimerization has been achieved as a proof of concept, this approach has not yet yielded a clinical candidate. The review covers the general strategies that led to some of the most useful inhibitors, the reasons for our limited success in effectively inhibiting this retroviral target in a clinical setting, current progress with second-generation inhibitors, and new avenues for research.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Anti-HIV Agents* / chemistry
  • Anti-HIV Agents* / pharmacology
  • Anti-HIV Agents* / therapeutic use
  • Antiretroviral Therapy, Highly Active
  • HIV Infections / drug therapy*
  • HIV Infections / enzymology
  • HIV Protease / metabolism*
  • HIV Protease Inhibitors* / chemistry
  • HIV Protease Inhibitors* / pharmacology
  • HIV Protease Inhibitors* / therapeutic use
  • HIV-1 / enzymology*
  • Humans
  • Molecular Structure
  • Structure-Activity Relationship

Substances

  • Anti-HIV Agents
  • HIV Protease Inhibitors
  • HIV Protease