A study published in the October issue of the journal Pediatrics looked at the use of HIV Pre-exposure Prophylaxis, or PrEP, in adolescents over a three-year period. This medication, given as a pill daily or as a long-acting injection every two months, was approved for adults in 2012 and for teens weighing over 35 kilograms (approximately 80 pounds), in 2018. It is a safe, effective anti-retroviral medication which can prevent HIV infection in individuals at high risk of exposure to HIV. The medication works to block replication of the virus if it enters the body, thereby reducing the viral load and preventing viral exposure from becoming viral infection.
PrEP is recommended for teens and adults with high risk for contracting HIV, either by intravenous drug use or via high risk sexual activity. Higher risk sexual activity where PrEP would be recommended includes “being sexually active and having any of the following: a recent bacterial sexually transmitted infection, inconsistent or no condom use, a sexual partner who has HIV, a high number of sexual partners, exchange sex, or having sex in an area or sexual network with a high prevalence of HIV,” according to study authors.
Of the nearly 40,000 new cases of HIV diagnosed each year in the U.S., 20% are in adolescents. While adult use of the preventative medication is widespread, it was not known how frequently adolescents were using this method of HIV prevention until recently. The study, performed at the Division of HIV Prevention at the Centers for Disease Control, reviewed the frequency, trend, and prescriber patterns of oral PrEP in 13- to 19-year-olds between 2018 and 2021.
Over the three-year period, there was an overall 76% rise in teen use of PrEP, with the majority of the group of PrEP users being male and 18- or 19-year-olds. There was a slight plateau in usage, although still with a slight rise, during the early months of the Covid-19 pandemic, followed by a sharp rise in 2021. Interestingly, only 30% of the 2400 PrEP prescribers were pediatricians, although it was unclear whether the other prescribers were family practitioners, internists, or clinicians at general clinics or urgent care centers.
In 2021, there were nearly 1500 newly diagnosed cases of HIV in adolescents ages 13-19. That year, 6400 adolescents in this age group received prescriptions for PrEP. The majority (over 80%) were male and either 18- or 19-years-old, and over 95% were living in urban areas. Even with this male majority, female use of PrEP also increased over the three-year-period, and all age groups, even in the group as young as 13- to 14-year-olds, showed an increase in receiving this medication in the time period studied.
While the American Academy of Pediatrics recommends discussion of considering PrEP in at-risk adolescents, a surprisingly low percentage of PrEP prescribers are pediatricians. Future incorporation of sexual health and risks for infections needs to be more widely used in this clinician population.