- Pache, Lars;
- Marsden, Matthew D;
- Teriete, Peter;
- Portillo, Alex J;
- Heimann, Dominik;
- Kim, Jocelyn T;
- Soliman, Mohamed SA;
- Dimapasoc, Melanie;
- Carmona, Camille;
- Celeridad, Maria;
- Spivak, Adam M;
- Planelles, Vicente;
- Cosford, Nicholas DP;
- Zack, Jerome A;
- Chanda, Sumit K
"Shock and kill" strategies focus on purging the latent HIV-1 reservoir by treating infected individuals with therapeutics that activate the latent virus and subsequently eliminating infected cells. We have previously reported that induction of non-canonical nuclear factor κB (NF-κB) signaling through a class of small-molecule antagonists known as Smac mimetics can reverse HIV-1 latency. Here, we describe the development of Ciapavir (SBI-0953294), a molecule specifically optimized for HIV-1 latency reversal that was found to be more efficacious as a latency-reversing agent than other Smac mimetics under clinical development for cancer. Critically, this molecule induced activation of HIV-1 reservoirs in vivo in a bone marrow, liver, thymus (BLT) humanized mouse model without mediating systemic T cell activation. This study provides proof of concept for the in vivo efficacy and safety of Ciapavir and indicates that Smac mimetics can constitute a critical component of a safe and efficacious treatment strategy to eliminate the latent HIV-1 reservoir.