Topical application of entry inhibitors as "virustats" to prevent sexual transmission of HIV infection

Abstract

With the continuing march of the AIDS epidemic and little hope for an effective vaccine in the near future, work to develop a topical strategy to prevent HIV infection is increasingly important. This stated, the track record of large scale "microbicide" trials has been disappointing with nonspecific inhibitors either failing to protect women from infection or even increasing HIV acquisition. Newer strategies that target directly the elements needed for viral entry into cells have shown promise in non-human primate models of HIV transmission and as these agents have not yet been broadly introduced in regions of highest HIV prevalence, they are particularly attractive for prophylaxis. We review here the agents that can block HIV cellular entry and that show promise as topical strategies or "virustats" to prevent mucosal transmission of HIV infection.

Figure 1

HIV entry and its inhibition. In the native conformation of Env, a canopy of three gp120 molecules (green) covers gp41, holding the trimer in a metastable conformation. Binding to cellular lectins (black) keeps Env close to the cellular membrane, facilitating subsequent interactions with CD4 (orange) and a chemokine receptor (CoR, purple). These gp120/receptor interactions trigger gp41 to extend and insert its N-terminal fusion peptide segment (red) into the target cell membrane. Ultimately, the exposed heptad repeat segments in the N- and C-terminal regions of the gp41 ectodomain [labeled N (gray) and C (blue)] associate to form the trimer-of-hairpins structure, juxtaposing viral and cellular membranes in a manner crucial for membrane fusion. HIV entry inhibitors investigated as potential topical prevention strategies are listed in red below each modeled transition.