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[Comment] Antiretroviral chemoprophylaxis: PROUD and pragmatism

About 20 years ago, very shortly after antiretroviral drugs were first shown to inhibit HIV replication and improve clinical outcomes, studies of animals showed that pre-exposure and post-exposure antiretroviral treatment could protect against retroviral challenges.1 The first use of antiviral drugs for chemoprophylaxis in human beings was that of zidovudine in HIV-infected pregnant women to prevent transmission to their children.2 Subsequently, seven efficacy trials of antiretroviral primary prevention have shown that tenofovir-based regimens can prevent HIV acquisition in African male and female heterosexuals, men and transgender women who have sex with men in Asia, Africa, Europe, and the Americas, and men and women in Thailand who inject drugs.