Key Takeaways
Extended Takeaways
- Among commercially insured people with bipolar disorder, male sex was strongly associated with both incident HIV diagnosis and PrEP receipt, with aOR=5.30 [4.22–6.65] for HIV and aOR=11.6 [10.0–13.5] for any PrEP, suggesting prevention efforts should particularly target men while not overlooking women who may still be at risk.
- Claims-based markers of sexual risk were powerful signals for PrEP prescribing but still identified major missed opportunities: high-risk sexual behavior was associated with aOR=16.9 [14.7–19.4] for any PrEP, yet among those with ≥4 STI encounters only 3.53% (n = 246) received any PrEP and 2.73% (n = 190) received at least 3 months of PrEP.
- Comorbid stimulant use disorder marked elevated vulnerability on both sides of the prevention equation, with greater odds of HIV diagnosis (aOR=2.40 [1.71–3.39]) and greater odds of PrEP prescription (aOR=1.49 [1.19–1.87]); opioid use disorder and cannabis use disorder, however, were associated with lower likelihood of PrEP prescription at aOR=0.67 [0.52–0.87] and aOR=0.69 [0.57–0.83], respectively.
- Care setting mattered: compared with primary care only follow-up, psychiatry-only outpatient care was associated with greater odds of HIV diagnosis (aOR=1.58 [1.11–2.27], P =.01), while having both psychiatry and primary care encounters was associated with higher odds of any PrEP prescription (aOR=1.38 [1.21–1.57], P<.001).
- Temporal trends show that prevention efforts have not kept pace with risk in bipolar disorder: HIV incidence per 100 person-years increased from 0.54% in 2010 to 1.08% in 2022, while any PrEP prescription rose from 0.27% to 8.94% and at least 3-month PrEP prescription rose from 0.00% to 6.34%.
- The cohort was young and psychiatrically complex, with 29.7% age between 14–24 years, 3.78% (n=12,631) diagnosed with comorbid StUD, and 4.92% (n=16,423) with comorbid OUD, supporting routine HIV risk assessment in bipolar disorder care rather than waiting for patients to present in sexual health settings.
