Antiretroviral (ARV) drugs can be used for HIV postexposure prophylaxis (PEP) within 72 hours after exposure to the virus to prevent the risk of acquiring an infection. In 2005, CDC issued guidelines for PEP use and updated its recommendations in 2016. However, awareness of and access to PEP has been low, and population-level estimates of PEP use are lacking. In this study, we compared PEP and preexposure prophylaxis (PrEP) uptake among persons with commercial health insurance in the United States.
Using 2005-2015 MarketScan health services data, we developed an algorithm to identify persons prescribed PEP each year. First, we included persons who filled any ARV prescription in a given year and defined the earliest ARV prescription as the index date. Next, we excluded persons with HIV infection identified by an HIV diagnostic code or an ARV prescription before the index date. We further excluded persons with hepatitis B virus (HBV) infection if they had an HBV diagnosis and ARV prescriptions used to treat HBV. Lastly, we excluded possible PrEP users if their medications was prescribed for >30 days. Using similar methods, we estimated PrEP uptake for persons with a Truvada prescription on the index date who used it for >30 days. We characterized PEP users and estimated the prevalence of PEP and PrEP use by year.
The number of persons prescribed PEP increased from 576 in 2005 to 2,797 in 2015; the prevalence of the PEP use increased from 32.8 per million in 2005 to 98.7 per million in 2015 (Ptrend <.001). The mean age of PEP users ranged from 34.1-36.4 years. The proportion of the male users among all users increased from 60% before 2014 to 70% after 2014. PEP use increased in metropolitan statistical areas from 90% in 2005 to 97% in 2015. When stratified by sex, the prevalence of male PEP users nearly quadrupled from 2005 (40.9 per million) to 2015 (149.2 per million) (Ptrend <.001); while the prevalence of the female users nearly doubled (from 25.3 per million in 2005 to 51.5 per million in 2015) (Ptrend <.001). Increases in PEP use mirrored increases in PrEP use (Figure).
We found an increasing trend in the prevalence of both PEP and PrEP use during 2005-2015. The increase in PEP use might be associated with increased awareness of PEP as a result of PrEP social media and educational campaigns that included information on PEP. Our methodology provides a feasible approach to estimate PEP use at the population level among users of private health insurance.