Nearly 15% of patients who initiated human immunodeficiency virus preexposure prophylaxis had an alcohol use disorder diagnosis within 6 months, yet fewer than 1 in 10 received FDA-approved treatment, according to a recent study.
Researchers conducted a retrospective cohort study evaluating the prevalence and treatment of alcohol use disorder (AUD) among commercially insured patients who initiated HIV preexposure prophylaxis (PrEP). The study analyzed data from 43,913 patients aged 16 to 64 years who received a new PrEP prescription between 2014 and 2021 using MarketScan health insurance claims.
The study assessed the occurrence of AUD diagnoses within 6 months prior to or following PrEP initiation and evaluated the use of FDA–approved and non–FDA-approved medications for AUD (MAUDs). Researchers, led by Anton L. V. Avanceña of The University of Texas at Austin, and colleagues, also examined associations between sociodemographic and clinical factors and the presence of AUD using multivariable logistic regression models.
Among the cohort, 6,274 patients (14.29%) had an AUD diagnosis: 1,245 (2.84%) prior and 5,029 (11.45%) following PrEP initiation. The mean age was 35.8 (10.94) years, and 90.1% (35,027) were male assigned at birth. AUD diagnosis was associated with co-occurring mental health conditions, including depression (adjusted odds ratio [OR], 3.26 prior to PrEP; OR, 3.17 following PrEP) and anxiety (OR, 2.16 prior; OR, 2.24 following). A strong association was also observed with substance use disorders (OR, 14.54 prior; OR, 13.09 following).
Despite frequent health care contact, only 531 of 6,274 patients with AUD (8.46%) received an FDA-approved MAUD. Among those diagnosed prior toPrEP initiation, 146 (11.73%) received oral naltrexone, while 233 (4.63%) in the post-PrEP group received the same treatment. Disulfiram and acamprosate were used far less frequently. Non–FDA-approved MAUDs such as gabapentin were more commonly prescribed (15.02% prior; 9.33% after), followed by topiramate and baclofen.
Source: JAMA Network Open
Commentary: Mental Health & Substance Use
“Mental health conditions are important to identify and address alongside PrEP services, as these disorders may impact adherence to PrEP, risk behaviors, and well-being. Routine use of brief validated screening tools to screen for anxiety, depression, and substance use (e.g. GAD-7, PHQ-9, AUDIT-C) is one strategy to integrate these assessments into regular care while minimizing burden on clinicians, and facilitate ongoing conversations about these issues,” said Larissa Mooney, MD, in an interview with Conexiant.
"Evaluation and treatment for AUD, psychiatric disorders, and HIV are often provided by specialists who are not co-located in the same clinic. Clinicians may feel inadequately trained in the use of FDA-approved medications for AUD or may lack confidence in the effectiveness of these medications. Whenever possible, these services should be integrated to improve efficiency, treatment outcomes, and access to care," said Dr. Mooney, Professor of Clinical Psychiatry, UCLA David Geffen School of Medicine, Los Angeles.
“It is best to use non-stigmatizing, nonjudgemental language when discussing substance use disorders, and integrate questions alongside discussion of other chronic conditions. Use of brief validated screening instruments may standardize the approach and open the door to more in-depth, patient-centered dialogue,” concluded Dr. Mooney.
