GS-7340 and GS-9131 {9-[(R)-2-[[(S)-[[(S)-1-(isopropoxycarbonyl)ethyl]amino]phenoxyphosphinyl]methoxy]-propyl]adenine and 9-(R)-4-(R)-[[[(S)-1-[(ethoxycarbonyl)ethyl]amino]phenoxyphosphinyl]methoxy]-Tenofovir {9-R-[(2-phosphonomethoxy)propyl]adenine} (TFV), an acyclic nucleotide analog of dAMP, is a potent in vitro and in vivo inhibitor of human immunodeficiency virus type 1 (HIV-1) replication (2). TFV is sequentially phosphorylated in the cell by AMP kinase and nucleoside diphosphate kinase to the active species, tenofovir diphosphate (23, 39), which acts as a potent inhibitor of HIV-1 reverse transcriptase (7,49). The presence of a nonhydrolyzable phosphonic acid moiety in tenofovir circumvents an initial phosphorylation step which can be rate limiting for the activation of nucleoside analog inhibitors of HIV reverse transcriptase (3, 4).In order to increase the cellular permeability and oral bioavailability of TFV, which is a dianion at physiological pH, neutral prodrugs of TFV have been synthesized. Tenofovir disoproxil fumarate (TDF) is a bis-isopropoxycarbonyloxymethyl ester prodrug of TFV approved for the treatment of HIV. TDF is well tolerated, with infrequent development of resistance and a favorable long-term toxicity profile (2,8, 16). The oral administration of TDF results in high systemic levels of TFV (5); however, the rapid systemic degradation of TDF to TFV limits its uptake into target cells.Investigations to develop plasma-stable prodrugs which would be selectively hydrolyzed inside cells to antiviral nucleotides led to the design of GS-7340 and GS-9131{9--fluoro-1Ј-furanyladenine, respectively}, alkylalaninyl amidate phenyl ester prodrugs of TFV and a cyclic nucleotide analog, GS-9148 (phosphonomethoxy-2Ј-fluoro-2Ј,3Ј-dideoxydidehydroadenosine), respectively. Both GS-7340 and GS-9131 exhibit potent in vitro anti-HIV-1 activities, favorable resistance profiles, and low cytotoxicities (9, 25). Compared to TDF, GS-7340 is significantly more stable in plasma and delivers ϳ30-fold-greater levels of active diphosphate metabolites into peripheral blood mononuclear cells (PBMCs) in vitro and in vivo (12). Compared to what was seen for TDF, oral administration of an equal dose of GS-7340 resulted in significantly higher levels of TFV accumulation both in lymphatic tissues and in PBMCs (24). While GS-7340 and other amidate prodrugs of tenofovir successfully validated the concept of enhanced in vivo intracellular delivery of parent nucleotide, GS-9131 has been selected as a clinical development candidate based on its unique activity against HIV-1 strains resistant to approved antiretroviral nucleosides and its favorable in vivo pharmacological properties, including the ability to effectively deliver the active GS-9148 diphosphate metabolite into PBMCs (9, 36). The prodrug moieties of GS-7340 and GS-9131 are structurally similar to a class of nucleoside monophosphate pro-* Corresponding author. Mailing address: Gilead Sciences, Inc., 333 Lakeside Drive, Foster City, CA 94404.