Resistance profile of the HIV-1 maturation inhibitor GSK3532795 in vitro and in a clinical study

PLoS One. 2019 Oct 17;14(10):e0224076. doi: 10.1371/journal.pone.0224076. eCollection 2019.

Abstract

GSK3532795 (formerly BMS955176) is a second-generation maturation inhibitor (MI) that progressed through a Phase 2b study for treatment of HIV-1 infection. Resistance development to GSK3532795 was evaluated through in vitro methods and was correlated with information obtained in a Phase 2a proof-of-concept study in HIV-1 infected participants. Both low and high concentrations of GSK3532795 were used for selections in vitro, and reduced susceptibility to GSK3532795 mapped specifically to amino acids near the capsid/ spacer peptide 1 (SP1) junction, the cleavage of which is blocked by MIs. Two key substitutions, A364V or V362I, were selected, the latter requiring secondary substitutions to reduce susceptibility to GSK3532795. Three main types of secondary substitutions were observed, none of which reduced GSK3532795 susceptibility in isolation. The first type was in the capsid C-terminal domain and downstream SP1 region (including (Gag numbering) R286K, A326T, T332S/N, I333V and V370A/M). The second, was an R41G substitution in viral protease that occurred with V362I. The third was seen in the capsid N-terminal domain, within the cyclophilin A binding domain (V218A/M, H219Q and G221E). H219Q increased viral replication capacity and reduced susceptibility of poorly growing viruses. In the Phase 2a study, a subset of these substitutions was also observed at baseline and some were selected following GSK35323795 treatment in HIV-1-infected participants.

Publication types

  • Clinical Trial, Phase II

MeSH terms

  • Anti-HIV Agents / pharmacology
  • Anti-HIV Agents / therapeutic use*
  • Capsid Proteins / genetics
  • Drug Resistance, Viral / genetics*
  • Genotype
  • HIV Infections / drug therapy*
  • HIV Protease / genetics
  • HIV-1 / genetics
  • HIV-1 / isolation & purification
  • HIV-1 / physiology
  • Humans
  • Mutation
  • Virus Replication / drug effects
  • gag Gene Products, Human Immunodeficiency Virus / genetics

Substances

  • Anti-HIV Agents
  • Capsid Proteins
  • gag Gene Products, Human Immunodeficiency Virus
  • HIV Protease

Grants and funding

Funding for all studies described came directly from Bristol-Myers Squibb. The funder provided support in the form of salaries for all authors but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of these authors are articulated in the ‘author contributions’ section.