1 in 7 HIV PrEP Users Face Alcohol Use Disorder

Nearly 12% of individuals using preexposure prophylaxis (PrEP) for HIV prevention, were diagnosed with alcohol use disorder (AUD) within 6 months of initiating PrEP, whereas nearly 3% were diagnosed before initiation. Fewer than 9% of those diagnosed received any US Food and Drug Administration (FDA)–approved medication for AUD.
METHODOLOGY:
Researchers carried out a retrospective cohort study using data from the US health claims to assess the prevalence of AUD among individuals using PrEP for the prevention of HIV.
They included 43,913 individuals (mean age, 35.8 years; 90.1% men) who received a PrEP prescription between January 2014 and December 2021.
The study outcome was an AUD diagnosis within 6 months before or after PrEP initiation, identified using suitable codes in inpatient and outpatient service claims.
Individuals diagnosed with AUD were evaluated for receipt of FDA-approved medications, including oral and injectable naltrexone, acamprosate, and disulfiram. The use of non–FDA-approved medications such as baclofen, gabapentin, and topiramate was also estimated.
TAKEAWAY:
Overall, 14.29% of PrEP users had an AUD diagnosis — 2.84% were diagnosed before and 11.45% were diagnosed after initiating PrEP.
Among individuals diagnosed with AUD, only 8.46% of them received FDA-approved medications, whereas gabapentin was the most frequently prescribed non-FDA approved medication.
Those assigned male at birth were less likely to be diagnosed with AUD both before starting PrEP (adjusted odds ratio [aOR], 0.62; P < .001) and after starting PrEP (aOR, 0.81; P < .001).
< .001) and after starting PrEP (aOR, 0.81; < .001). Individuals with an AUD diagnosis were significantly more likely to have mental health disorders, including depression, anxiety, posttraumatic stress disorder, and bipolar disorder ( P < .001 for all); testing for sexually transmitted infections was also more common among those with an AUD diagnosis.
IN PRACTICE:
'Given the prominence of unhealthy alcohol use among candidates for PrEP, standardized screening for unhealthy alcohol use and, as indicated, assessment for AUD are needed by clinicians. All clinicians, including those working in primary care and sexual health clinics, ought to be comfortable talking about and managing unhealthy alcohol use,' the authors of an invited commentary wrote.
SOURCE:
This study was led by Anton L.V. Avanceña, PhD, The University of Texas at Austin. It was published online on April 25, 2025, in JAMA Network Open .
LIMITATIONS:
Reliance on health claims data may have led to the omission of those without insurance or those seeking care outside conventional healthcare settings. The health claims database only included individuals with employer-sponsored commercial insurance, possibly affecting the generalizability of the findings. Moreover, the database did not provide information on gender, sexual orientation, race, or ethnicity.
DISCLOSURES:
This study was supported by the Texas Institute for Sexual and Gender Minority Health Research, the Dell Medical School Office of Research and the Office of Health Equity, and the National Center for Advancing Translational Sciences of the National Institutes of Health. One author reported receiving grants from Merck Sharp & Dohme outside the submitted work.

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