CROI 2025 Conference Coverage

Low Uptake of HIV PrEP Among At-Risk US Adolescents, Young Adults

Edited by:
Anthony Calabro, MA

Key Highlights

  • Only 2.2% of at-risk US adolescents and young adults filled a preexposure prophylaxis (PrEP) prescription.
  • Those younger than 18 years had markedly low PrEP uptake (0.8%).
  • Older age, male sex, and psychiatric diagnoses were associated with higher odds of PrEP use.
  • Residence in states with LGBTQ+ legal protections increased the likelihood of PrEP prescribing.

A nationwide analysis reported persistently low use of HIV preexposure prophylaxis (PrEP) among at-risk adolescents and young adults (AYA) in the United States. The study authors defined AYA as commercially insured youth aged 13 to 21 years with ICD-10 codes indicating bacterial sexually transmitted infections (chlamydia, gonorrhea, or syphilis) or documented high-risk sexual behaviors, which are clinical indicators that typically warrant consideration of PrEP.

Despite representing a population with disproportionately high HIV incidence, PrEP uptake in this age group remained limited during 2018–2023, according to the study, which was presented at the Conference on Retroviruses and Opportunistic Infections 2025 in San Francisco, CA.

Using the IBM Marketscan insurance claims database, investigators identified commercially insured AYA aged 13 to 21 years with ICD-10 codes for bacterial sexually transmitted infections or high-risk sexual behaviors that would typically indicate clinical need for PrEP. Youth with HIV, prior PrEP use, or antiretroviral prescriptions not intended for PrEP were excluded.

Filled PrEP prescriptions were identified through pharmacy claims. The researchers used logistic regression to assess associations between PrEP uptake and demographic, clinical, and geographic variables, including age, sex, psychiatric disorders, substance use, US region, state laws related to adolescent HIV consent, and LGBTQ+ legal protections.

Study Findings

Among 101,148 eligible AYA, just 2.2% (n = 2209) received a PrEP prescription. Uptake was substantially lower in minors: only 0.8% (197 of 23,670) of youth younger than 18 filled a prescription. Male sex was strongly associated with PrEP use (adjusted odds ratio [aOR] 16.3; 95% CI, 14.3–18.5). Older adolescents had higher odds of PrEP receipt, including those aged 18–19 years (aOR 2.6; 95% CI, 2.2–3.1) and 20–21 years (aOR 3.5; 95% CI, 3.0–4.1). Mental health diagnoses were also associated with PrEP uptake (aOR 1.7; 95% CI, 1.6–1.8).

Youth diagnosed with gonorrhea or syphilis were more likely to receive PrEP than those with chlamydia. Substance use and year of cohort entry were not associated with prescribing patterns. Geographically, AYA living in the Northeast (aOR 2.0; 95% CI, 1.4–3.0) or West (aOR 1.7; 95% CI, 1.1–2.7) had higher odds of receiving PrEP than those in the South. State-level LGBTQ+ legal protections were associated with increased PrEP uptake (aOR 1.4; 95% CI, 1.3–1.5), whereas adolescent HIV consent laws were not.

Clinical Implications

According to the study authors, these findings indicate that PrEP remains substantially underused among US adolescents and young adults who have clinical indications for HIV prevention. They noted that demographic factors, clinical diagnoses, and state policy environments may influence access to or utilization of PrEP, underscoring the need to expand supportive systems and interventions.

Expert Commentary

“Efforts to increase PrEP use among youth are needed, including greater adoption of supportive policies,” the researchers concluded.

Reference
Venturelli N, Krakower D, Garabedian L. Low rates of HIV preexposure prophylaxis prescriptions among US youth in a claims database. Presented at: CROI 2025, San Francisco, CA. March 9-12. https://www.croiconference.org/croi-2025-resources/#1704917615220-bd2a0030-6e2a.