Cure of human immunodeficiency virus/acquired immune deficiency syndrome: promising future prospects at horizon.

Acquired immune deficiency syndrome (AIDS) is a disease caused by human immunodeficiency virus and characterized by profound immunosuppression that leads to opportunistic infections, secondary neoplasms, and neurologic complications. AIDS is among the leading causes of death worldwide. Current therapeutic options are directed only toward management of AIDS, but not toward its prevention or cure. In addition, it also possesses numerous problems like drug resistance, drug toxicity, drug interactions, non-adherence to therapy, life-long and expensive treatment, etc. Recent years in drug development have shown promising prospects for prevention/ treatment/cure of AIDS like histone deacetylase inhibitors, Vpu ion channel inhibitors, viral decay acceleration, maturation inhibitors, tat antagonists, gene/stem cell therapy, and antiretroviral vaccines.

Pharmacological intervention of HIV-1 maturation

Despite significant advances in antiretroviral therapy, increasing drug resistance and toxicities observed among many of the current approved human immunodeficiency virus (HIV) drugs indicate a need for discovery and development of potent and safe antivirals with a novel mechanism of action. Maturation inhibitors (MIs) represent one such new class of HIV therapies. MIs inhibit a late step in the HIV-1 Gag processing cascade, causing defective core condensation and the release of non-infectious virus particles from infected cells, thus blocking the spread of the infection to new cells. Clinical proof-of-concept for the MIs was established with betulinic acid derived bevirimat, the prototype HIV-1 MI. Despite the discontinuation of its further clinical development in 2010 due to a lack of uniform patient response caused by naturally occurring drug resistance Gag polymorphisms, several second-generation MIs with improved activity against viruses exhibiting Gag polymorphism mediated resistance have been recently discovered and are under clinical evaluation in HIV/AID patients. In this review, current understanding of HIV-1 MIs is described and recent progress made toward elucidating the mechanism of action, target identification and development of second-generation MIs is reviewed.