Antiviral JAK inhibitors useful in treating or preventing retroviral and other viral infections
Compounds, compositions, and methods of treatment and prevention of HIV infection are disclosed. The compounds are pyrrolo[2,3-b]pyridines and pyrrolo[2,3-b]pyrimidine JAK inhibitors. Combinations of these JAK inhibitors and additional antiretroviral compounds, such as NRTI, NNRTI, integrase inhibitors, entry inhibitors, protease inhibitors, and the like, are also disclosed. In one embodiment, the combinations include a combination of adenine, cytosine, thymidine, and guanine nucleoside antiviral agents, optionally in further combination with at least one additional antiviral agent that works via a different mechanism than a nucleoside analog. This combination has the potential to eliminate the presence of HIV in an infected patient.
1. A method for treating an HIV infection, comprising administering to a patient in need thereof an effective antiviral amount of a compound of Formula B:
including pharmaceutically acceptable salt forms or prodrugs thereof, wherein:
A 1 and A 2 are independently selected from C and N;
T, U, and V are independently selected from O, S, N, CR 5 , and NR 6 ;
wherein the 5-membered ring formed by A 1 , A 2 , U, T, and V is aromatic;
X is N or CR 4 ;
Y is C 1-8 alkylene, C 2-8 alkenylene, C 2-8 alkynylene, (CR 11 R 12 ) p —(C 3-10 cycloalkylene)-(CR 11 R 12 ) q , (CR 11 R 12 ) p -(arylene)-(CR 11 R 12 ) q , (CR 11 R 12 ) p —(C 1-10 heterocycloalkylene)-(CR 11 R 12 ) q , (CR 11 R 12 ) p -(heteroarylene)-(CR 11 R 12 ) q , (CR 11 R 12 ) p O(CR 11 R 12 ) q , (CR 11 R 12 ) p S(CR 11 R 12 ) q , (CR 11 R 12 ) p C(O)(CR 11 R 12 ) q , (CR 11 R 12 ) p C(O)NR c (CR 11 R 12 ) q , (CR 11 R 12 ) p C(O)O(CR 11 R 12 ) q , (CR 11 R 12 ) p OC(O)(CR 11 R 12 ) q , (CR 11 R 12 ) p OC(O)NR c (CR 11 R 12 ) q , (CR 11 R 12 ) p NR c (CR 11 R 12 ) q , (CR 11 R 12 ) p NR c C(O)NR d (CR 11 R 12 ) q , (CR 11 R 12 ) p S(O)(CR 11 R 12 ) q , (CR 11 R 12 ) p S(O)NR c (CR 11 R 12 ) q , (CR 11 R 12 ) p S(O) 2 (CR 11 R 12 ) q , or (CR 11 R 12 ) p S(O) 2 NR(CR 11 R 12 ) q , wherein said C 1-8 alkylene, C 2-8 alkenylene, C 2-8 alkynylene, cycloalkylene, arylene, heterocycloalkylene, or heteroarylene, is optionally substituted with 1, 2, or 3 substituents independently selected from -D 1 -D 2 -D 3 -D 4 ;
Z is H, halo, C 1-4 alkyl, C 2-4 alkenyl, C 2-4 alkynyl, C 1-4 haloalkyl, halosulfanyl, C 1-4 hydroxyalkyl, C 1-4 cyanoalkyl, ═C—R i , ═N—R i , Cy 1 , CN, NO 2 , OR a , SR a , C(O)R b , C(O)NR c R d , C(O)OR a , OC(O)R b , OC(O)NR c R d , NR c R d , NR c C(O)R b , NR c C(O)NR c R d , NR c C(O)OR a , C(═NR i )NR c R d , NR c C(═NR i )NR c R d , S(O)R b , S(O)NR c R d , S(O) 2 R b , NR c S(O) 2 R b , C(═NOH)R b , C(═NO(C 1-6 alkyl)R b , and S(O) 2 NR c R d , wherein said C 1-8 alkyl, C 2-8 alkenyl, or C 2-8 alkynyl, is optionally substituted with 1, 2, 3, 4, 5, or 6 substituents independently selected from halo, C 1-4 alkyl, C 2-4 alkenyl, C 2-4 alkynyl, C 1-4 haloalkyl, halosulfanyl, C 1-4 hydroxyalkyl, C 1-4 cyanoalkyl, Cy 1 , CN, N 2 , OR a , SR a , C(O)R b , C(O)NR c R d , C(O)OR a , OC(O)R b , OC(O)NR c R d , NR c R d , NR c C(O)R b , NR c C(O)NR c R d , NR c C(O)OR a , C(═NR i )NR c R d , NR c C(═NR i )NR c R d , S(O)R b , S(O)NR c R d , S(O) 2 R b , NR c S(O) 2 R b , C(═NOH)R b , C(═NO(C 1-6 alkyl))R b , and S(O) 2 NR c R d ;
wherein when Z is H, n is 1;
or the —(Y) n —Z moiety is taken together with i) A 2 to which the moiety is attached, ii) R 5 or R 6 of either T or V, and iii) the C or N atom to which the R 5 or R 6 of either T or V is attached to form a 4- to 20-membered aryl, cycloalkyl, heteroaryl, or heterocycloalkyl ring fused to the 5-membered ring formed by A 1 A 2 , U, T, and V, wherein said 4- to 20-membered aryl, cycloalkyl, heteroaryl, or heterocycloalkyl ring is optionally substituted by 1, 2, 3, 4, or 5 substituents independently selected from —(W) m -Q;
W is C 1-8 alkylenyl, C 2-8 alkenylenyl, C 2-8 alkynylenyl, O, S, C(O), C(O)NR c′ , C(O)O, OC(O), OC(O)NR c′ , NR c′ , NR c′ C(O)NR d′ , S(O), S(O)NR c′ , S(O) 2 , or S(O)2NR c′ ;
Q is H, halo, CN, NO 2 , C 1-8 alkyl, C 2-8 alkenyl, C 2-8 alkynyl, C 1-8 haloalkyl, halosulfanyl, aryl, cycloalkyl, heteroaryl, or heterocycloalkyl, wherein said C 1-8 alkyl, C 2-8 alkenyl, C 2-8 alkynyl, C 1-8 haloalkyl, aryl, cycloalkyl, heteroaryl, or heterocycloalkyl is optionally substituted with 1, 2, 3 or 4 substituents independently selected from halo, C 1-4 alkyl, C 2-4 alkenyl, C 2-4 alkynyl, C 1-4 haloalkyl, halosulfanyl, C 1-4 hydroxyalkyl, C 1-4 cyanoalkyl, Cy 2 , CN, NO 2 , OR a′ , SR a′ , C(O)R b′ , C(O)NR c′ R d′ , C(O)OR a′ , OC(O)R b′ , OC(O)NR c′ R d′ , NR c′ R d′ , NR c′ C(O)R b′ , NR c′ C(O)N R c′ R d ′, N R c′ C(O)OR a′ , S(O)R b′ , S(O)N R c′ R d′ , S(O) 2 R b′ , NR c ′S(O) 2 R b′ , and S(O) 2 N R c′ R d′ ;
Cy 1 and Cy 2 are independently selected from aryl, heteroaryl, cycloalkyl, and heterocycloalkyl, each optionally substituted by 1, 2, 3, 4 or 5 substituents independently selected from halo, C 1-4 alkyl, C 2-4 alkenyl, C 2-4 alkynyl, C 1-4 haloalkyl, halosulfanyl, C 1-4 hydroxyalkyl, C 1-4 cyanoalkyl, CN, NO 2 , OR a″ , SR a″ , C(O)R b ″, C(O)NR c′ ′R d″ , C(O)OR a″ , OC(O)R b″ , OC(O)N R c′ ′R d″ , NR c′ ′R d″ , NR c′ ′C(O)R b″ , NR c″ C(O)OR a″ , NR c″ S(O)R b″ , NR c″ S(O) 2 R b ″, S(O)R b″ , S(O)NR c″ R d″ , S(O) 2 R b″ , and S(O) 2 NR c″ R d″ ;
R 1 , R 2 , R 3 , and R 4 are independently selected from H, halo, C 1-4 alkyl, C 2-4 alkenyl, C 2-4 alkynyl, C 1-4 haloalkyl, halosulfanyl, aryl, cycloalkyl, heteroaryl, heterocycloalkyl, CN, NO 2 , OR 7 , SR 7 , C(O)R 8 , C(O)NR 9 R 1 0, C(O)OR 7 OC(O)R 8 , OC(O)NR 9 R 10 , NR 9 R 10 , NR 9 C(O)R 8 , NR c C(O)OR 7 , S(O)R 8 , S(O)NR 9 R 10 , S(O) 2 R 8 , NR 9 S(O) 2 R 8 , and S(O) 2 NR 9 R 10 ;
R 5 is H, halo, C 1-4 alkyl, C 2-4 alkenyl, C 2-4 alkynyl, C 1-4 haloalkyl, halosulfanyl, CN, NO 2 , OR 7 , SR 7 , C(O)R 8 , C(O)NR 9 R 10 , C(O)OR 7 , OC(O)R 8 , OC(O)NR 9 R 10 , NR 9 R 10 , NR 9 C(O)R 8 , NR 9 C(O)OR 7 , S(O)R 8 , S(O)NR 9 R 10 , S(O) 2 R 8 , NR 9 S(O) 2 R 8 , or S(O) 2 NR 9 R 10 ;
R 6 is H, C 1-4 alkyl, C 2-4 alkenyl, C 2-4 alkynyl, C 1-4 haloalkyl, OR 7 , C(O)R 8 , C(O)NR 9 R 10 , C(O)OR 7 , S(O)R 8 , S(O)NR 9 R 10 , S(O) 2 R 8 , or S(O) 2 NR 9 R 10 ;
R 7 is H, C 1-6 alkyl, C 1-6 haloalkyl, C 2-6 alkenyl, C 2-6 alkynyl, aryl, cycloalkyl, heteroaryl, heterocycloalkyl, arylalkyl, heteroarylalkyl, cycloalkylalkyl or heterocycloalkylalkyl;
R 8 is H, C 1-6 alkyl, C 1-6 haloalkyl, C 2-6 alkenyl, C 2-6 alkynyl, aryl, cycloalkyl, heteroaryl, heterocycloalkyl, arylalkyl, heteroarylalkyl, cycloalkylalkyl or heterocycloalkylalkyl;
R 9 and R 10 are independently selected from H, C 1-10 alkyl, C 1-6 haloalkyl, C 2-6 alkenyl, C 2-6 alkynyl, C 1-6 alkylcarbonyl, arylcarbonyl, C 1-6 alkylsulfonyl, arylsulfonyl, aryl, heteroaryl, cycloalkyl, heterocycloalkyl, arylalkyl, heteroarylalkyl, cycloalkylalkyl and heterocycloalkylalkyl;
or R 9 and R 10 together with the N atom to which they are attached form a 4-, 5-, 6- or 7-membered heterocycloalkyl group;
R 11 and R 12 are independently selected from H and -E 1 -E 2 -E 3 -E 4 ;
D 1 and E 1 are independently absent or independently selected from C 1-6 alkylene, C 2-6 alkenylene, C 2-6 alkynylene, arylene, cycloalkylene, heteroarylene, and heterocycloalkylene, wherein each of the C 1-6 alkylene, C 2-6 alkenylene, C 2-6 alkynylene, arylene, cycloalkylene, heteroarylene, and heterocycloalkylene is optionally substituted by 1, 2 or 3 substituents independently selected from halo, CN, NO 2 , N 3 , SCN, OH, C 1-6 alkyl, C 1-6 haloalkyl, C 2-8 alkoxyalkyl, C 1-6 alkoxy, C 1-6 haloalkoxy, amino, C 1-6 alkylamino, and C 2-8 dialkylamino;
D 2 and E 2 are independently absent or independently selected from C 1-6 alkylene, C 2-6 alkenylene, C 2-6 alkynylene, (C 1-6 alkylene) r -O—(C 1-6 alkylene) s , (C 1-6 alkylene) r -S—(C 1-6 alkylene) s , (C 1-6 alkylene) r -NR c —(C 1-6 alkylene) s , (C 1-6 alkylene) r -CO—(C 1-6 alkylene) s , (C 1-6 alkylene) r -COO—(C 1-6 alkylene) s , (C 1-6 alkylene) r -CONR c —(C 1-6 alkylene) s , (C 1-6 alkylene) r -SO—(C 1-6 alkylene) s , (C 1-6 alkylene) r -SO 2 —(C 1-6 alkylene) s , (C 1-6 alkylene) r -SONR c —(C 1-6 alkylene) s , and (C 1-6 alkylene) r -NR c CONR f —(C 1-6 alkylene) s , wherein each of the C 1-6 alkylene, C 2-6 alkenylene, and C 2-6 alkynylene is optionally substituted by 1, 2 or 3 substituents independently selected from halo, CN, NO 2 , N 3 , SCN, OH, C 1-6 alkyl, C 1-6 haloalkyl, C 2-8 alkoxyalkyl, C 1-6 alkoxy, C 1-6 haloalkoxy, amino, C 1-6 alkylamino, and C 2-8 dialkylamino;
D 3 and E 3 are independently absent or independently selected from C 1-6 alkylene, C 2-6 alkenylene, C 2-6 alkynylene, arylene, cycloalkylene, heteroarylene, and heterocycloalkylene, wherein each of the C 1-6 alkylene, C 2-6 alkenylene, C 2-6 alkynylene, arylene, cycloalkylene, heteroarylene, and heterocycloalkylene is optionally substituted by 1, 2 or 3 substituents independently selected from halo, CN, NO 2 , N 3 , SCN, OH, C 1-6 alkyl, C 1-6 haloalkyl, C 2-8 alkoxyalkyl, C 1-6 alkoxy, C 1-6 haloalkoxy, amino, C 1-6 alkylamino, and C 2-8 dialkylamino;
E 4 and E 4 are independently selected from H, halo, C 1-4 alkyl, C 2-4 alkenyl, C 2-4 alkynyl, C 1-4 haloalkyl, halosulfanyl, C 1-4 hydroxyalkyl, C 1-4 cyanoalkyl, Cy 1 , CN, NO 2 , OR a , SR a , C(O)R b , C(O)NR c R a , C(O)OR a , OC(O)R b OC(O)NR c R d NR c R d , NR c C(O)R b , NR c C(O)NR c R d , NR c C(O)OR a , C(═NR i )NR c R d , NR c C(═NR i )NR c R d , S(O)R b , S(O)NR c R d , S(O) 2 R b , NR c S(O) 2 R b , C(═NOH)R b , C(═NO(C 1-6 alkyl)R b , and S(O) 2 NR c R d , wherein said C 1-8 alkyl, C 2-8 alkenyl, or C 2-8 alkynyl, is optionally substituted with 1, 2, 3, 4, 5, or 6 substituents independently selected from halo, C 1-4 alkyl, C 2-4 alkenyl, C 2-4 alkynyl, C 1-4 haloalkyl, halosulfanyl, C 1-4 hydroxyalkyl, C 1-4 cyanoalkyl, Cy 1 , CN, NO 2 , OR a , SR a , C(O)R b , C(O)NR c R d , C(O)OR a , OC(O)R b , OC(O)NR c R d , NR c R d , NR c C(O)R b , NR c C(O)NR c R d , NR c C(O)OR a , C(═NR i )NR c R d , NR c C(═NR i )NR c R d , S(O)R b , S(O)NR c R d , S(O) 2 R b , NR c S(O) 2 R b , C(═NOH)R b , C(═NO(C 1-6 alkyl))R b , and S(O) 2 NR c R d ;
R a is H, Cy 1 , —(C 1-6 alkyl)-Cy 1 , C 1-6 alkyl, C 1-6 haloalkyl, C 2-6 alkenyl, C 2-6 alkynyl, wherein said C 1-6 alkyl, C 1-6 haloalkyl, C 2-6 alkenyl, or C 2-6 alkynyl is optionally substituted with 1, 2, or 3 substituents independently selected from OH, CN, amino, halo, C 1-6 alkyl, C 1-6 haloalkyl, halosulfanyl, aryl, arylalkyl, heteroaryl, heteroarylalkyl, cycloalkyl and heterocycloalkyl;
R b is H, Cy 1 , —(C 1-6 alkyl)-Cy 1 , C 1-6 alkyl, C 1-6 haloalkyl, C 2-6 alkenyl, C 2-6 alkynyl, wherein said C 1-6 alkyl, C 1-61-6 haloalkyl, C 2-6 alkenyl, or C 2-6 alkynyl is optionally substituted with 1, 2, or 3 substituents independently selected from OH, CN, amino, halo, C 1-6 alkyl, C 1-6 haloalkyl, C 1-6 haloalkyl, halosulfanyl, aryl, arylalkyl, heteroaryl, heteroarylalkyl, cycloalkyl and heterocycloalkyl;
R a ′ and R a ″ are independently selected from H, C 1-6 alkyl, C 1-6 haloalkyl, C 2-6 alkenyl, C 2-6 alkynyl, aryl, cycloalkyl, heteroaryl, heterocycloalkyl, arylalkyl, heteroarylalkyl, cycloalkylalkyl and heterocycloalkylalkyl, wherein said C 1-6 alkyl, C 1-6 haloalkyl, C 2-6 alkenyl, C 2-6 alkynyl, aryl, cycloalkyl, heteroaryl, heterocycloalkyl, arylalkyl, heteroarylalkyl, cycloalkylalkyl or heterocycloalkylalkyl is optionally substituted with 1, 2, or 3 substituents independently selected from OH, CN, amino, halo, C 1-6 alkyl, C 1-6 haloalkyl, halosulfanyl, aryl, arylalkyl, heteroaryl, heteroarylalkyl, cycloalkyl and heterocycloalkyl;
R b′ and R b″ are independently selected from H, C 1-6 alkyl, C 1-6 haloalkyl, C 2-6 alkenyl, C 2-6 alkynyl, aryl, cycloalkyl, heteroaryl, heterocycloalkyl, arylalkyl, heteroarylalkyl, cycloalkylalkyl and heterocycloalkylalkyl, wherein said C 1-6 alkyl, C 1-6 haloalkyl, C 2-6 alkenyl, C 2-6 alkynyl, aryl, cycloalkyl, heteroaryl, heterocycloalkyl, arylalkyl, heteroarylalkyl, cycloalkylalkyl or heterocycloalkylalkyl is optionally substituted with 1, 2, or 3 substituents independently selected from OH, CN, amino, halo, C 1-6 alkyl, C 1-6 haloalkyl, C 1-6 haloalkyl, halosulfanyl, aryl, arylalkyl, heteroaryl, heteroarylalkyl, cycloalkyl and heterocycloalkyl;
R c and R d are independently selected from H, Cy 1 , —(C 1-6 alkyl)-Cy 1 , C 1-10 alkyl, C 1-6 haloalkyl, C 2-6 alkenyl, C 2-6 alkynyl, wherein said C 1-10 alkyl, C 1-6 haloalkyl, C 2-6 alkenyl, or C 2-6 alkynyl, is optionally substituted with 1, 2, or 3 substituents independently selected from Cy 1 , —(C 1-6 alkyl)-Cy 1 , OH, CN, amino, halo, C 1-6 alkyl, C 1-6 haloalkyl, C 1-6 haloalkyl, and halosulfanyl;
or R c and R d together with the N atom to which they are attached form a 4-, 5-, 6- or 7-membered heterocycloalkyl group optionally substituted with 1, 2, or 3 substituents independently selected from Cy 1 , —(C 1-6 alkyl)-Cy 1 , OH, CN, amino, halo, C 1-6 alkyl, C 1-6 haloalkyl, C 1-6 haloalkyl, and halosulfanyl;
R c ′ and R d ′ are independently selected from H, C 1-10 alkyl, C 1-6 haloalkyl, C 2-6 alkenyl, C 2-6 alkynyl, aryl, heteroaryl, cycloalkyl, heterocycloalkyl, arylalkyl, heteroarylalkyl, cycloalkylalkyl and heterocycloalkylalkyl, wherein said C 1-10 alkyl, C 1-6 haloalkyl, C 2-6 alkenyl, C 2-6 alkynyl, aryl, heteroaryl, cycloalkyl, heterocycloalkyl, arylalkyl, heteroarylalkyl, cycloalkylalkyl or heterocycloalkylalkyl is optionally substituted with 1, 2, or 3 substituents independently selected from OH, CN, amino, halo, C 1-6 alkyl, C 1-6 haloalkyl, C 1-6 haloalkyl, halosulfanyl, aryl, arylalkyl, heteroaryl, heteroarylalkyl, cycloalkyl and heterocycloalkyl;
or R c ′ and R d ′ together with the N atom to which they are attached form a 4-, 5-, 6- or 7-membered heterocycloalkyl group optionally substituted with 1, 2, or 3 substituents independently selected from OH, CN, amino, halo, C 1-6 alkyl, C 1-6 haloalkyl, C 1-6 haloalkyl, halosulfanyl, aryl, arylalkyl, heteroaryl, heteroarylalkyl, cycloalkyl and heterocycloalkyl;
R c ″ and R d ″ are independently selected from H, C 1-10 alkyl, C 1-6 haloalkyl, C 2-6 alkenyl, C 2-6 alkynyl, aryl, heteroaryl, cycloalkyl, heterocycloalkyl, arylalkyl, heteroarylalkyl, cycloalkylalkyl and heterocycloalkylalkyl, wherein said C 1-10 alkyl, C 1-6 haloalkyl, C 2-6 alkenyl, C 2-6 alkynyl, aryl, heteroaryl, cycloalkyl, heterocycloalkyl, arylalkyl, heteroarylalkyl, cycloalkylalkyl or heterocycloalkylalkyl is optionally substituted with 1, 2, or 3 substituents independently selected from OH, CN, amino, halo, C 1-6 alkyl, C 1-6 haloalkyl, halosulfanyl, C 1-6 haloalkyl, aryl, arylalkyl, heteroaryl, heteroarylalkyl, cycloalkyl and heterocycloalkyl;
or R c ″ and R d ″ together with the N atom to which they are attached form a 4-, 5-, 6- or 7-membered heterocycloalkyl group optionally substituted with 1, 2, or 3 substituents independently selected from OH, CN, amino, halo, C 1-6 alkyl, C 1-6 haloalkyl, C 1-6 haloalkyl, halosulfanyl, aryl, arylalkyl, heteroaryl, heteroarylalkyl, cycloalkyl and heterocycloalkyl;
R i is H, CN, NO 2 , or C 1-6 alkyl;
R e and R f are independently selected from H and C 1-6 alkyl;
R i is H, CN, or NO 2 ;
m is 0 or 1;
n is 0 or 1;
p is 0, 1, 2, 3, 4, 5, or 6;
q is 0, 1, 2, 3, 4, 5 or 6;
r is 0 or 1; and
s is 0 or 1.
2. The method of claim 1 , further comprising the co-administration of
a) at least one each of an adenine, cytosine, thymidine, and guanine nucleoside antiviral agent, or
b) at least one additional antiviral agent selected from the group consisting of non-nucleoside reverse transcriptase inhibitors (NNRTI), protease inhibitors, fusion inhibitors, entry inhibitors, attachment inhibitors, and integrase inhibitors.
3. The method of claim 1 , wherein the compound of Formula B is
or a pharmaceutically acceptable salt or prodrug thereof.
4. The method of claim 1 , further comprising the co-administration of a macrophage depleting agent.
5. A method of treating or eradicating an HIV infection, comprising:
a) reducing viral loads in a patient by administering a combination of HAART and a JAK inhibitor as claimed in claim 1 ,
b) systemically depleting macrophages with a macrophage depleting agent while maintaining HAART and JAK inhibitor therapy until a sufficient amount of macrophages are depleted, as determined, for example, by flow cytometry that a low level or no macrophages are present in the circulating periphery upon blood draw,
c) withdrawing treatment with the macrophage depleting agent, while maintaining treatment with HAART and the JAK inhibitor, where withdrawal of HAART and/or JAK inhibitor is executed upon sustained low level or absent viremia, and
d) either withdrawing HAART while JAK inhibitor therapy is maintained, or withdrawing both HAART and JAK inhibitor therapy, optionally while monitoring viral rebound.
6. The method of claim 5 , wherein the macrophage depleting agent is Boniva or Fosamax.
7. The method of claim 5 , wherein the JAK inhibitor is
or a pharmaceutically acceptable salt or prodrug thereof.
8. A method of treating or eradicating an HIV infection, comprising:
a) reducing viral loads in a patient by administering a combination of HAART and a JAK inhibitor as claimed in claim 1 ,
b) administering a reactivation agent, while maintaining one or both of HAART and JAK inhibitor therapy,
c) withdrawing treatment with the reactivation agent, upon assessment of increased viral loads in the periphery that may be coupled with but not limited to assessment of diminished or absent memory lymphocytes with flow cytometry, while continuing treatment with HAART and one or more JAK inhibitors, until low level or absent viremia is maintained,
d) withdrawing HAART, while JAK inhibitor therapy is maintained, or withdrawing both HAART and JAK inhibitor therapy, optionally while monitoring viral rebound.
9. The method of claim 8 , wherein the reactivation agent is panobinostat.
10. The method of claim 8 , wherein the JAK inhibitor is
or a pharmaceutically acceptable salt or prodrug thereof.
11. A method of treating or eradicating an HIV infection, comprising:
a) reducing viral loads in a patient by administering a JAK inhibitor as claimed in claim 1 , and
b) administering an anti-HIV vaccine and/or an immunostimulatory/immunomodulatory agent before, during, or after the JAK inhibitor is administered.
12. The method of claim 11 , further comprising administration of HAART along with the JAK inhibitor.
13. The method of claim 12 , wherein the HAART comprises the co-administration of
a) at least one each of an adenine, cytosine, thymidine, and guanine nucleoside antiviral agent, or
b) at least one additional antiviral agent selected from the group consisting of non-nucleoside reverse transcriptase inhibitors (NNRTI), protease inhibitors, fusion inhibitors, entry inhibitors, attachment inhibitors, and integrase inhibitors.
14. The method of claim 12 , wherein the JAK inhibitor, HAART, and vaccine or immunostimulatory/immunomodulatory compound are administered in combination.
15. The method of claim 12 , wherein the JAK inhibitor, HAART, and vaccine or immunostimulatory/immunomodulatory compound are administered in alternation.
16. A pharmaceutical composition comprising a compound of Formula B:
including pharmaceutically acceptable salt forms or prodrugs thereof, wherein:
A 1 and A 2 are independently selected from C and N;
T, U, and V are independently selected from O, S, N, CR 5 , and NR 6 ;
wherein the 5-membered ring formed by A 1 , A 2 , U, T, and V is aromatic;
X is N or CR 4 ;
Y is C 1-8 alkylene, C 2-8 alkenylene, C 2-8 alkynylene, (CR 11 R 12 ) p —(C 3-10 cycloalkylene)-(CR 11 R 12 ) q , (CR 11 R 12 ) p -(arylene)-(CR 11 R 12 ) q , (CR 11 R 12 ) \p —(C 1-10 heterocycloalkylene)-(CR 11 R 12 ) q , (CR 11 R 12 ) p -(heteroarylene)-(CR 11 R 12 ) q , (CR 11 R 12 ) p O(CR 11 R 12 ) q , (CR 11 R 12 ) p S(CR 11 R 12 ) q , (CR 11 R 12 ) p C(O)(CR 11 R 12 ) q , (CR 11 R 12 ) p C(O)NR c (CR 11 R 12 ) q , (CR 11 R 12 ) p C(O)O(CR 11 R 12 ) q , (CR 11 R 12 ) p OC(O)(CR 11 R 12 ) q , (CR 11 R 12 ) p OC(O)NR c (CR 11 R 12 ) q , (CR 11 R 12 ) p NR c (CR 11 R 12 ) q , (CR 11 R 12 ) p NR c C(O)NR d (CR 11 R 12 ) q , (CR 11 R 12 ) p S(O)(CR 11 R 12 ) q , (CR 11 R 12 ) p S(O)NR c (CR 11 R 12 ) q , (CR 11 R 12 ) p S(O) 2 (CR 11 R 12 ) q , or (CR 11 R 12 ) p S(O) 2 NR c (CR 11 R 12 ) q , wherein said C 1-8 alkylene, C 2-8 alkenylene, C 2-8 alkynylene, cycloalkylene, arylene, heterocycloalkylene, or heteroarylene, is optionally substituted with 1, 2, or 3 substituents independently selected from -D 1 -D 2 -D 3 -D 4 ;
Z is H, halo, C 1-4 alkyl, C 2-4 alkenyl, C 2-4 alkynyl, C 1-4 haloalkyl, halosulfanyl, C 1-4 hydroxyalkyl, C 1-4 cyanoalkyl, ═C—R i , ═N—R i , Cy 1 , CN, NO 2 , OR a , SR a , C(O)R b , C(O)NR c R d , C(O)OR a , OC(O)R b , OC(O)NR c R d , NR c R d , NR c C(O)R b , NR c C(O)NR c R d , NR c C(O)OR a , C(═NR i )NR c R d , NR c C(═NR i )NR c R d , S(O)R b , S(O)NR c R d , S(O) 2 R b , NR c S(O) 2 R b , C(═NOH)R b , C(═NO(C 1-6 alkyl)R b , and S(O) 2 NR c R d , wherein said C 1-8 alkyl, C 2-8 alkenyl, or C 2-8 alkynyl, is optionally substituted with 1, 2, 3, 4, 5, or 6 substituents independently selected from halo, C 1-4 alkyl, C 2-4 alkenyl, C 2-4 alkynyl, C 1-4 haloalkyl, halosulfanyl, C 1-4 hydroxyalkyl, C 1-4 cyanoalkyl, Cy 1 , CN, N 2 , OR a , SR a , C(O)R b , C(O)NR c R d , C(O)OR a , OC(O)R b , OC(O)NR c R d , NR c R d , NR c C(O)R b , NR c C(O)NR c R d , NR c C(O)OR a , C(═NR i )NR c R d , NR c C(═NR i )NR c R d , S(O)R b , S(O)NR c R d , S(O) 2 R b , NR c S(O) 2 R b , C(═NOH)R b , C(═NO(C 1-6 alkyl))R b , and S(O) 2 NR c R d ;
wherein when Z is H, n is 1;
or the —(Y) n —Z moiety is taken together with i) A 2 to which the moiety is attached, ii) R 5 or R 6 of either T or V, and iii) the C or N atom to which the R 5 or R 6 of either T or V is attached to form a 4- to 20-membered aryl, cycloalkyl, heteroaryl, or heterocycloalkyl ring fused to the 5-membered ring formed by A 1 A 2 , U, T, and V, wherein said 4- to 20-membered aryl, cycloalkyl, heteroaryl, or heterocycloalkyl ring is optionally substituted by 1, 2, 3, 4, or 5 substituents independently selected from —(W) m -Q;
W is C 1-8 alkylenyl, C 2-8 alkenylenyl, C 2-8 alkynylenyl, O, S, C(O), C(O)NR c′ , C(O)O, OC(O), OC(O)NR c′ , NR c′ , NR c′ C(O)NR d′ , S(O), S(O)NR c′ , S(O) 2 , or S(O)2NR c′ ;
Q is H, halo, CN, NO 2 , C 1-8 alkyl, C 2-8 alkenyl, C 2-8 alkynyl, C 1-8 haloalkyl, halosulfanyl, aryl, cycloalkyl, heteroaryl, or heterocycloalkyl, wherein said C 1-8 alkyl, C 2-8 alkenyl, C 2-8 alkynyl, C 1-8 haloalkyl, aryl, cycloalkyl, heteroaryl, or heterocycloalkyl is optionally substituted with 1, 2, 3 or 4 substituents independently selected from halo, C 1-4 alkyl, C 2-4 alkenyl, C 2-4 alkynyl, C 1-4 haloalkyl, halosulfanyl, C 1-4 hydroxyalkyl, C 1-4 cyanoalkyl, Cy 2 , CN, NO 2 , OR a′ , SR a′ , C(O)R b′ , C(O)NR c′ R d′ , C(O)OR a′ , OC(O)R b′ , OC(O)NR c′ R d′ , NR c′ R d′ , NR c′ C(O)R b′ , NR c′ C(O)N R c R d ′, N R c′ C(O)OR a′ , S(O)R b′ , S(O)N R c′ R d′ , S(O) 2 R b′ , NR c ′S(O) 2 R b′ , and S(O) 2 N R c′ R d′ ;
Cy 1 and Cy 2 are independently selected from aryl, heteroaryl, cycloalkyl, and heterocycloalkyl, each optionally substituted by 1, 2, 3, 4 or 5 substituents independently selected from halo, C 1-4 alkyl, C 2-4 alkenyl, C 2-4 alkynyl, C 1-4 haloalkyl, halosulfanyl, C 1-4 hydroxyalkyl, C 1-4 cyanoalkyl, CN, NO 2 , OR a″ , SR a″ , C(O)R b ″, C(O)NR c′ ′R d″ , C(O)OR a″ , OC(O)R b″ , OC(O)N R c′ ′R d″ , NR c′ ′R d″ , NR c′ ′C(O)R b″ , NR c″ C(O)OR a″ , NR c″ S(O)R b″ , NR c″ S(O) 2 R b″ , S(O)R b ″, S(O)NR c″ R d″ , S(O) 2 R b″ , and S(O) 2 NR c″ R d″ ;
R 1 , R 2 , R 3 , and R 4 are independently selected from H, halo, C 1-4 alkyl, C 2-4 alkenyl, C 2-4 alkynyl, C 1-4 haloalkyl, halosulfanyl, aryl, cycloalkyl, heteroaryl, heterocycloalkyl, CN, NO 2 , OR 7 , SR 7 , C(O)R 8 , C(O)NR 9 R 1 0, C(O)OR 7 OC(O)R 8 , OC(O)NR 9 R 10 , NR 9 R 10 , NR 9 C(O)R 8 , NR c C(O)OR 7 , S(O)R 8 , S(O)NR 9 R 10 , S(O) 2 R 8 , NR 9 S(O) 2 R 8 , and S(O) 2 NR 9 R 10 ;
R 5 is H, halo, C 1-4 alkyl, C 2-4 alkenyl, C 2-4 alkynyl, C 1-4 haloalkyl, halosulfanyl, CN, NO 2 , OR 7 , SR 7 , C(O)R 8 , C(O)NR 9 R 10 , C(O)OR 7 , OC(O)R 8 , OC(O)NR 9 R 10 , NR 9 R 10 , NR 9 C(O)R 8 , NR 9 C(O)OR 7 , S(O)R 8 , S(O)NR 9 R 10 , S(O) 2 R 8 , NR 9 S(O) 2 R 8 , or S(O) 2 NR 9 R 10 ;
R 6 is H, C 1-4 alkyl, C 2-4 alkenyl, C 2-4 alkynyl, C 1-4 haloalkyl, OR 7 , C(O)R 8 , C(O)NR 9 R 10 , C(O)OR 7 , S(O)R 8 , S(O)NR 9 R 10 , S(O) 2 R 8 , or S(O) 2 NR 9 R 10 ;
R 7 is H, C 1-6 alkyl, C 1-6 haloalkyl, C 2-6 alkenyl, C 2-6 alkynyl, aryl, cycloalkyl, heteroaryl, heterocycloalkyl, arylalkyl, heteroarylalkyl, cycloalkylalkyl or heterocycloalkylalkyl;
R 8 is H, C 1-6 alkyl, C 1-6 haloalkyl, C 2-6 alkenyl, C 2-6 alkynyl, aryl, cycloalkyl, heteroaryl, heterocycloalkyl, arylalkyl, heteroarylalkyl, cycloalkylalkyl or heterocycloalkylalkyl;
R 9 and R 10 are independently selected from H, C 1-10 alkyl, C 1-6 haloalkyl, C 2-6 alkenyl, C 2-6 alkynyl, C 1-6 alkylcarbonyl, arylcarbonyl, C 1-6 alkylsulfonyl, arylsulfonyl, aryl, heteroaryl, cycloalkyl, heterocycloalkyl, arylalkyl, heteroarylalkyl, cycloalkylalkyl and heterocycloalkylalkyl;
or R 9 and R 10 together with the N atom to which they are attached form a 4-, 5-, 6- or 7-membered heterocycloalkyl group;
R 11 and R 12 are independently selected from H and -E 1 -E 2 -E 3 -E 4 ;
D 1 and E 1 are independently absent or independently selected from C 1-6 alkylene, C 2-6 alkenylene, C 2-6 alkynylene, arylene, cycloalkylene, heteroarylene, and heterocycloalkylene, wherein each of the C 1-6 alkylene, C 2-6 alkenylene, C 2-6 alkynylene, arylene, cycloalkylene, heteroarylene, and heterocycloalkylene is optionally substituted by 1, 2 or 3 substituents independently selected from halo, CN, NO 2 , N 3 , SCN, OH, C 1-6 alkyl, C 1-6 haloalkyl, C 2-8 alkoxyalkyl, C 1-6 alkoxy, C 1-6 haloalkoxy, amino, C 1-6 alkylamino, and C 2-8 dialkylamino;
D 2 and E 2 are independently absent or independently selected from C 1-6 alkylene, C 2-6 alkenylene, C 2-6 alkynylene, (C 1-6 alkylene) r -O—(C 1-6 alkylene) s , (C 1-6 alkylene) r -S—(C 1-6 alkylene) s , (C 1-6 alkylene) r -NR c —(C 1-6 alkylene) s , (C 1-6 alkylene) r -CO—(C 1-6 alkylene) s , (C 1-6 alkylene) r -COO—(C 1-6 alkylene) s , (C 1-6 alkylene) r -CONR c —(C 1-6 alkylene) s , (C 1-6 alkylene) r -SO—(C 1-6 alkylene) s , (C 1-6 alkylene) r -SO 2 —(C 1-6 alkylene) s , (C 1-6 alkylene) r -SONR c —(C 1-6 alkylene) s , and (C 1-6 alkylene) r -NR c CONR f —(C 1-6 alkylene) s , wherein each of the C 1-6 alkylene, C 2-6 alkenylene, and C 2-6 alkynylene is optionally substituted by 1, 2 or 3 substituents independently selected from halo, CN, NO 2 , N 3 , SCN, OH, C 1-6 alkyl, C 1-6 haloalkyl, C 2-8 alkoxyalkyl, C 1-6 alkoxy, C 1-6 haloalkoxy, amino, C 1-6 alkylamino, and C 2-8 dialkylamino;
D 3 and E 3 are independently absent or independently selected from C 1-6 alkylene, C 2-6 alkenylene, C 2-6 alkynylene, arylene, cycloalkylene, heteroarylene, and heterocycloalkylene, wherein each of the C 1-6 alkylene, C 2-6 alkenylene, C 2-6 alkynylene, arylene, cycloalkylene, heteroarylene, and heterocycloalkylene is optionally substituted by 1, 2 or 3 substituents independently selected from halo, CN, NO 2 , N 3 , SCN, OH, C 1-6 alkyl, C 1-6 haloalkyl, C 2-8 alkoxyalkyl, C 1-6 alkoxy, C 1-6 haloalkoxy, amino, C 1-6 alkylamino, and C 2-8 dialkylamino;
E 4 and E 4 are independently selected from H, halo, C 1-4 alkyl, C 2-4 alkenyl, C 2-4 alkynyl, C 1-4 haloalkyl, halosulfanyl, C 1-4 hydroxyalkyl, C 1-4 cyanoalkyl, Cy 1 , CN, NO 2 , OR a , SR a , C(O)R b , C(O)NR c R a , C(O)OR a , OC(O)R b OC(O)NR c R d NR c R d , NR c C(O)R b , NR c C(O)NR c R d , NR c C(O)OR a , C(═NR i )NR c R d , NR c C(═NR i )NR c R d , S(O)R b , S(O)NR c R d , S(O) 2 R b , NR c S(O) 2 R b , C(═NOH)R b , C(═NO(C 1-6 alkyl)R b , and S(O) 2 NR c R d , wherein said C 1-8 alkyl, C 2-8 alkenyl, or C 2-8 alkynyl, is optionally substituted with 1, 2, 3, 4, 5, or 6 substituents independently selected from halo, C 1-4 alkyl, C 2-4 alkenyl, C 2-4 alkynyl, C 1-4 haloalkyl, halosulfanyl, C 1-4 hydroxyalkyl, C 1-4 cyanoalkyl, Cy 1 , CN, NO 2 , OR a , SR a , C(O)R b , C(O)NR c R d , C(O)OR a , OC(O)R b , OC(O)NR c R d , NR c R d , NR c C(O)R b , NR c C(O)NR c R d , NR c C(O)OR a , C(═NR i )NR c R d , NR c C(═NR i )NR c R d , S(O)R b , S(O)NR c R d , S(O) 2 R b , NR c S(O) 2 R b , C(═NOH)R b , C(═NO(C 1-6 alkyl))R b , and S(O) 2 NR c R d ;
R a is H, Cy 1 , —(C 1-6 alkyl)-Cy 1 , C 1-6 alkyl, C 1-6 haloalkyl, C 2-6 alkenyl, C 2-6 alkynyl, wherein said C 1-6 alkyl, C 1-6 haloalkyl, C 2-6 alkenyl, or C 2-6 alkynyl is optionally substituted with 1, 2, or 3 substituents independently selected from OH, CN, amino, halo, C 1-6 alkyl, C 1-6 haloalkyl, halosulfanyl, aryl, arylalkyl, heteroaryl, heteroarylalkyl, cycloalkyl and heterocycloalkyl;
R b is H, Cy 1 , —(C 1-6 alkyl)-Cy 1 , C 1-6 alkyl, C 1-6 haloalkyl, C 2-6 alkenyl, C 2-6 alkynyl, wherein said C 1-6 alkyl, C 1-61-6 haloalkyl, C 2-6 alkenyl, or C 2-6 alkynyl is optionally substituted with 1, 2, or 3 substituents independently selected from OH, CN, amino, halo, C 1-6 alkyl, C 1-6 haloalkyl, C 1-6 haloalkyl, halosulfanyl, aryl, arylalkyl, heteroaryl, heteroarylalkyl, cycloalkyl and heterocycloalkyl;
R a ′ and R a ″ are independently selected from H, C 1-6 alkyl, C 1-6 haloalkyl, C 2-6 alkenyl, C 2-6 alkynyl, aryl, cycloalkyl, heteroaryl, heterocycloalkyl, arylalkyl, heteroarylalkyl, cycloalkylalkyl and heterocycloalkylalkyl, wherein said C 1-6 alkyl, C 1-6 haloalkyl, C 2-6 alkenyl, C 2-6 alkynyl, aryl, cycloalkyl, heteroaryl, heterocycloalkyl, arylalkyl, heteroarylalkyl, cycloalkylalkyl or heterocycloalkylalkyl is optionally substituted with 1, 2, or 3 substituents independently selected from OH, CN, amino, halo, C 1-6 alkyl, C 1-6 haloalkyl, halosulfanyl, aryl, arylalkyl, heteroaryl, heteroarylalkyl, cycloalkyl and heterocycloalkyl;
R b′ and R b″ are independently selected from H, C 1-6 alkyl, C 1-6 haloalkyl, C 2-6 alkenyl, C 2-6 alkynyl, aryl, cycloalkyl, heteroaryl, heterocycloalkyl, arylalkyl, heteroarylalkyl, cycloalkylalkyl and heterocycloalkylalkyl, wherein said C 1-6 alkyl, C 1-6 haloalkyl, C 2-6 alkenyl, C 2-6 alkynyl, aryl, cycloalkyl, heteroaryl, heterocycloalkyl, arylalkyl, heteroarylalkyl, cycloalkylalkyl or heterocycloalkylalkyl is optionally substituted with 1, 2, or 3 substituents independently selected from OH, CN, amino, halo, C 1-6 alkyl, C 1-6 haloalkyl, C 1-6 haloalkyl, halosulfanyl, aryl, arylalkyl, heteroaryl, heteroarylalkyl, cycloalkyl and heterocycloalkyl;
R c and R d are independently selected from H, Cy 1 , —(C 1-6 alkyl)-Cy 1 , C 1-10 alkyl, C 1-6 haloalkyl, C 2-6 alkenyl, C 2-6 alkynyl, wherein said C 1-10 alkyl, C 1-6 haloalkyl, C 2-6 alkenyl, or C 2-6 alkynyl, is optionally substituted with 1, 2, or 3 substituents independently selected from Cy 1 , —(C 1-6 alkyl)-Cy 1 , OH, CN, amino, halo, C 1-6 alkyl, C 1-6 haloalkyl, C 1-6 haloalkyl, and halosulfanyl;
or R c and R d together with the N atom to which they are attached form a 4-, 5-, 6- or 7-membered heterocycloalkyl group optionally substituted with 1, 2, or 3 substituents independently selected from Cy 1 , —(C 1-6 alkyl)-Cy 1 , OH, CN, amino, halo, C 1-6 alkyl, C 1-6 haloalkyl, C 1-6 haloalkyl, and halosulfanyl;
R c ′ and R d ′ are independently selected from H, C 1-10 alkyl, C 1-6 haloalkyl, C 2-6 alkenyl, C 2-6 alkynyl, aryl, heteroaryl, cycloalkyl, heterocycloalkyl, arylalkyl, heteroarylalkyl, cycloalkylalkyl and heterocycloalkylalkyl, wherein said C 1-10 alkyl, C 1-6 haloalkyl, C 2-6 alkenyl, C 2-6 alkynyl, aryl, heteroaryl, cycloalkyl, heterocycloalkyl, arylalkyl, heteroarylalkyl, cycloalkylalkyl or heterocycloalkylalkyl is optionally substituted with 1, 2, or 3 substituents independently selected from OH, CN, amino, halo, C 1-6 alkyl, C 1-6 haloalkyl, C 1-6 haloalkyl, halosulfanyl, aryl, arylalkyl, heteroaryl, heteroarylalkyl, cycloalkyl and heterocycloalkyl;
or R c ′ and R d ′ together with the N atom to which they are attached form a 4-, 5-, 6- or 7-membered heterocycloalkyl group optionally substituted with 1, 2, or 3 substituents independently selected from OH, CN, amino, halo, C 1-6 alkyl, C 1-6 haloalkyl, C 1-6 haloalkyl, halosulfanyl, aryl, arylalkyl, heteroaryl, heteroarylalkyl, cycloalkyl and heterocycloalkyl;
R c ″ and R d ″ are independently selected from H, C 1-10 alkyl, C 1-6 haloalkyl, C 2-6 alkenyl, C 2-6 alkynyl, aryl, heteroaryl, cycloalkyl, heterocycloalkyl, arylalkyl, heteroarylalkyl, cycloalkylalkyl and heterocycloalkylalkyl, wherein said C 1-10 alkyl, C 1-6 haloalkyl, C 2-6 alkenyl, C 2-6 alkynyl, aryl, heteroaryl, cycloalkyl, heterocycloalkyl, arylalkyl, heteroarylalkyl, cycloalkylalkyl or heterocycloalkylalkyl is optionally substituted with 1, 2, or 3 substituents independently selected from OH, CN, amino, halo, C 1-6 alkyl, C 1-6 haloalkyl, halosulfanyl, C 1-6 haloalkyl, aryl, arylalkyl, heteroaryl, heteroarylalkyl, cycloalkyl and heterocycloalkyl;
or R c ″ and R d ″ together with the N atom to which they are attached form a 4-, 5-, 6- or 7-membered heterocycloalkyl group optionally substituted with 1, 2, or 3 substituents independently selected from OH, CN, amino, halo, C 1-6 alkyl, C 1-6 haloalkyl, C 1-6 haloalkyl, halosulfanyl, aryl, arylalkyl, heteroaryl, heteroarylalkyl, cycloalkyl and heterocycloalkyl;
R i is H, CN, NO 2 , or C 1-6 alkyl;
R e and R f are independently selected from H and C 1-6 alkyl;
R i is H, CN, or NO 2 ;
m is 0 or 1;
n is 0 or 1;
p is 0, 1, 2, 3, 4, 5, or 6;
q is 0, 1, 2, 3, 4, 5 or 6;
r is 0 or 1; and
s is 0 or 1,
a pharmaceutically acceptable carrier or excipient, and an additional anti-HIV compound.
17. The pharmaceutical composition of claim 16 , wherein the an additional anti-HIV compound is selected from the group consisting of non-nucleoside reverse transcriptase inhibitors (NNRTI), protease inhibitors, fusion inhibitors, entry inhibitors, attachment inhibitors, and integrase inhibitors.
18. The pharmaceutical composition of claim 17 , wherein the NNRTI is Sustiva, the protease inhibitor is Kaletra, or the integrase inhibitor is Raltegravir or Elvitegravir.
19. The pharmaceutical composition of claim 17 , wherein the compound of Formula
B is
or a pharmaceutically acceptable salt or prodrug thereof.
20. The pharmaceutical composition of claim 16 , further comprising a macrophage depleting agent.
21. The pharmaceutical composition of claim 20 , wherein the macrophage depleting agent is Boniva or Fosamax.
22. The pharmaceutical composition of claim 16 , further comprising a macrophage depleting agent or reactivation agent.
23. The pharmaceutical composition of claim 22 , wherein the JAK inhibitor is
or a pharmaceutically acceptable salt or prodrug thereof.
24. The pharmaceutical composition of claim 22 , wherein the reactivation agent is panobinostat.
25. The pharmaceutical composition of claim 16 , further comprising an anti-HIV vaccine and/or an immunostimulatory/immunomodulatory agent.