As long as the threat of human immunodeficiency virus (HIV) protease drug resistance still exists, there will be a need for more potent antiretroviral agents. We have therefore determined the crystal structures of HIV-1 protease in complex with six cyclic urea inhibitors: XK216, XK263, DMP323, DMP450, XV638, and SD146, in an attempt to identify 1) the key interactions responsible for their high potency and 2) new interactions that might improve their therapeutic benefit. The structures reveal that the preorganized, C 2 symmetric scaffolds of the inhibitors are anchored in the active site of the protease by six hydrogen bonds and that their P1 and P2 substituents participate in extensive van der Waals interactions and hydrogen bonds. Because all of our inhibitors possess benzyl groups at P1 and P1, their relative binding affinities are modulated by the extent of their P2 interactions, e.g. XK216, the least potent inhibitor (K i (inhibition constant) ؍ 4.70 nM), possesses the smallest P2 and the lowest number of P2-S2 interactions; whereas SD146, the most potent inhibitor (K i ؍ 0.02 nM), contains a benzimidazolylbenzamide at P2 and participates in fourteen hydrogen bonds and ϳ200 van der Waals interactions. This analysis identifies the strongest interactions between the protease and the inhibitors, suggests ways to improve potency by building into the S2 subsite, and reveals how conformational changes and unique features of the viral protease increase the binding affinity of HIV protease inhibitors.An essential step in the life cycle of the human immunodeficiency virus (HIV) 1 is the proteolytic cleavage of the viral polyprotein gene products of gag and gag-pol into active structural and replicative proteins (1, 2). The finding that a viralencoded protease is responsible for processing these precursors, and that its inactivation produces immature, noninfectious viral particles, elicited an intense search for synthetic inhibitors. The first competitive inhibitors of HIV protease (PR) were transition-state analogs (peptidomimetics) in which the scissile bonds were replaced with nonhydrolyzable isosteres such as a reduced amide, phosphinate, hydroxyethylene, dihydroxyethylene, statine, and hydroxyethylamine (3-5). Recently, the Food and Drug Administration (FDA) has approved the use of four peptidomimetic protease inhibitors (saquinavir, ritonavir, indinavir, and nelfinavir) to treat HIV infection. Although these compounds are potent inhibitors of the wild-type protease, their therapeutic benefit is, in most cases, short-lived because they select for variants of HIV that have a reduced sensitivity toward inhibitors, as a result of mutations within the HIV protease sequence (6 -10). In an attempt to delay the onset of drug resistance, the FDA approved the use of combination therapy, i.e. a mixture of protease and reverse transcriptase antiretroviral agents. Although multidrug therapy has reduced the plasma viral load of some HIV-infected individuals to undetectable levels (11), the daunting ability of the virus...