Maraviroc: a review of its use in HIV infection and beyond

Drug Des Devel Ther. 2015 Oct 1;9:5447-68. doi: 10.2147/DDDT.S90580. eCollection 2015.

Abstract

The human immunodeficiency virus-1 (HIV-1) enters target cells by binding its envelope glycoprotein gp120 to the CD4 receptor and/or coreceptors such as C-C chemokine receptor type 5 (CCR5; R5) and C-X-C chemokine receptor type 4 (CXCR4; X4), and R5-tropic viruses predominate during the early stages of infection. CCR5 antagonists bind to CCR5 to prevent viral entry. Maraviroc (MVC) is the only CCR5 antagonist currently approved by the United States Food and Drug Administration, the European Commission, Health Canada, and several other countries for the treatment of patients infected with R5-tropic HIV-1. MVC has been shown to be effective at inhibiting HIV-1 entry into cells and is well tolerated. With expanding MVC use by HIV-1-infected humans, different clinical outcomes post-approval have been observed with MVC monotherapy or combination therapy with other antiretroviral drugs, with MVC use in humans infected with dual-R5- and X4-tropic HIV-1, infected with different HIV-1 genotype or infected with HIV-2. This review discuss the role of CCR5 in HIV-1 infection, the development of the CCR5 antagonist MVC, its pharmacokinetics, pharmacodynamics, drug-drug interactions, and the implications of these interactions on treatment outcomes, including viral mutations and drug resistance, and the mechanisms associated with the development of resistance to MVC. This review also discusses available studies investigating the use of MVC in the treatment of other diseases such as cancer, graft-versus-host disease, and inflammatory diseases.

Keywords: AIDS; CCR5 antagonists; chemokine receptors; drug interactions; human immunodeficiency virus; mutations; pharmacodynamics; pharmacokinetics; resistance.

Publication types

  • Research Support, N.I.H., Extramural
  • Review
  • Comment

MeSH terms

  • Animals
  • Anti-Inflammatory Agents / therapeutic use
  • Antineoplastic Agents / therapeutic use
  • CCR5 Receptor Antagonists / adverse effects
  • CCR5 Receptor Antagonists / pharmacokinetics
  • CCR5 Receptor Antagonists / therapeutic use*
  • Cyclohexanes / adverse effects
  • Cyclohexanes / pharmacokinetics
  • Cyclohexanes / therapeutic use*
  • Drug Interactions
  • Drug Resistance, Viral / genetics
  • Genotype
  • HIV Fusion Inhibitors / adverse effects
  • HIV Fusion Inhibitors / pharmacokinetics
  • HIV Fusion Inhibitors / therapeutic use*
  • HIV Infections / diagnosis
  • HIV Infections / drug therapy*
  • HIV Infections / virology
  • HIV-1 / drug effects*
  • HIV-1 / genetics
  • HIV-1 / metabolism
  • Humans
  • Maraviroc
  • Mutation
  • Phenotype
  • Polypharmacy
  • Treatment Outcome
  • Triazoles / adverse effects
  • Triazoles / pharmacokinetics
  • Triazoles / therapeutic use*

Substances

  • Anti-Inflammatory Agents
  • Antineoplastic Agents
  • CCR5 Receptor Antagonists
  • Cyclohexanes
  • HIV Fusion Inhibitors
  • Triazoles
  • Maraviroc