Alcohol Use Disorder Diagnoses Among Individuals Who Take HIV Preexposure Prophylaxis

Alcohol use disorder (AUD) may negatively affect preexposure prophylaxis (PrEP) adherence and continuation, reducing PrEP effectiveness.

To estimate the prevalence of and and factors associated with AUD diagnoses among commercially insured individuals who take PrEP.

This retrospective cohort study used US health care claims data to identify individuals aged 16 to 64 years who received at least 1 new PrEP prescription between January 1, 2014, to December 31, 2021. Data were analyzed from June 2024 to February 2025.

Sociodemographic characteristics included patient age, sex, geographic location, employment status, and type of health insurance. Clinical characteristics included sexually transmitted infection (STI) diagnosis and testing, use of psychotherapy services, and diagnosis of other mental health conditions.

The main outcome was an AUD diagnosis within 6 months before or after the date of PrEP initiation. Among individuals with an AUD diagnosis, receipt of medications for AUD (MAUDs), including Food and Drug Administration (FDA)-approved MAUDs (acamprosate, disulfiram, and oral and injectable naltrexone) and non-FDA-approved MAUDs (baclofen, gabapentin, and topiramate) was determined.

The study cohort included 43 913 individuals receiving PrEP (mean [SD] age, 35.8 [10.94] years; 35 027 [90.1%] male assigned at birth). There were 6274 individuals (14.29%) who had an AUD diagnosis, with 1245 (2.84%) and 5029 (11.45%) receiving their diagnosis before and after PrEP initiation, respectively. The sociodemographic and clinical factors that were associated with an AUD diagnosis were similar whether AUD was diagnosed before or after PrEP initiation, including male sex assigned at birth (before: adjusted odds ratio [aOR], aOR, 0.62; 95% CI, 0.52-0.73; after: aOR, 0.81; 95% CI, 0.73-0.90) and the presence of other mental health diagnoses such as depression (before: aOR, 3.26; 95% CI, 2.78-3.84; after: aOR, 3.17; 95% CI, 2.88-3.49), anxiety (before: aOR, 2.16; 95% CI, 1.83-2.55; after: aOR, 2.24; 95% CI, 2.04-2.46), and any substance use disorder (before: aOR, 14.54; 95% CI, 12.46-16.96; after: aOR, 13.09; 95% CI, 11.82-14.49). There were 531 individuals with AUD diagnosis (8.46%) who received an FDA-approved MAUD and 883 (14.07%) who had a claim for a non-FDA-approved MAUD.

This population-based cohort study found that nearly 15% of individuals who took PrEP had an AUD diagnosis within 6 months of PrEP initiation; individuals with an AUD diagnosis were more likely to have co-occurring mental health conditions, and less than 9% received any FDA-approved MAUD. These findings suggest that interventions are needed to improve AUD services among individuals who take PrEP.