Current PrEP Algorithm:
An algorithm to differentiate the HIV treatment and HIV PrEP indications is built using prescription and diagnoses data for individuals taking Truvada (FTC/TDF) and its generic formulations (starting in 2020), Descovy (FTC/TAF) after its approval in 2019, or Apretude (cabotegravir) after its approval in 2021. For AIDSVu, the analyses determine total PrEP usage with FTC/TDF, FTC/TAF, or cabotegravir and not individually for each product.
The algorithm identifies and excludes individuals diagnosed with HIV or treated with other HIV agents, diagnosed with chronic Hepatitis B (CHB) or treated with CHB agents, or have post-exposure prophylaxis (PEP). The different categories for the indications are not mutually exclusive (for example, an individual may have both HIV and CHB). Individuals taking FTC/TDF, FTC/TAF, or cabotegravir are identified as taking PrEP if not eliminated due to diagnoses or treatment for HIV or CHB or have post-exposure prophylaxis (PEP) codes.
An individual with diagnosis or treatment codes for HIV, CHB or codes for PEP prior to the exposure era of FTC/TDF, FTC/TAF, or cabotegravir would be considered to not be taking PrEP.
Individuals who have monotherapy with FTC/TDF, FTC/TAF, or cabotegravir and ICD codes for HIV counseling (V6544, Z717) are classified as PrEP individuals.
The exclusion criteria in the algorithm includes the GPI codes that begin with 1210 (HIV specific antiretrovirals) and GPI codes that begin with 123520 (Hepatitis B specific agents). This list may vary with each database cut as new antiretrovirals and agents are added. The list should contain marketed products in the US, either individual agents or combination products. These lists will be updated annually.
Inclusion and Exclusion Criteria
Inclusion Criteria
The following are the study inclusion criteria:
- Individuals who have monotherapy with Truvada (FTC/TDF), including generic formulations, Descovy (FTC/TAF), or Apretude (cabotegravir)
Exclusion Criteria
The following are the study exclusion criteria:
- Individuals with HIV condition eras (see Exclusionary Conditions for a list of ICD-9/10-CM diagnoses codes that define HIV and opportunistic infections); or
- Individuals treated with other HIV agents (see Exclusionary Treatments for GPI codes that define HIV agents); or
- Individuals diagnosed with chronic Hepatitis B (CHB) (see Exclusionary Conditions for a list of ICD-9/10-CM diagnoses codes that define CHB); or
- Individuals treated with CHB agents (see Exclusionary Treatments for GPI codes that define CHB agents); or
- Individuals who have post-exposure prophylaxis (PEP) (see Exclusionary Conditions for a list of ICD-9/10-CM diagnoses codes that define PEP).
Codes and GPI Medication Codes Currently used in the PrEP Algorithm for Exclusionary Conditions and Exclusionary Treatments
Exclusionary Conditions
Condition | Exclusion Items | ICD-9-CM Diagnoses Codes* | ICD-10-CM Diagnoses Codes* |
HIV and opportunistic infections | HIV disease | 042 | B20 |
Asymptomatic HIV infection | V08 | Z21 | |
HIV-2 infection | 079.53 | B97.35 | |
HIV complicating pregnancy | NA | O98.7X | |
Nonspecific serologic evidence of HIV | 795.71 | R75 | |
Candidiasis of bronchi, trachea, or esophagus | 112.84 | B37.81 | |
Candidiasis of lungs | 112.4 | B37.1 | |
Toxoplasmosis | 130.X | B58.X | |
Coccidioidomycosis | 114.X | B38.X | |
Cryptococcosis | 117.5 | B45.X | |
Cryptosporidiosis | 007.4 | A07.2 | |
CMV retinitis | 078.5 | B25.8 | |
Kaposi’s sarcoma | 176.X | C46.X | |
Mycobacterium avium complex | 031.2, 031.0 | A31.0, A31.2 | |
Pneumocystis carinii pneumonia | 136.3 | B59 | |
CHB | Chronic hepatitis B infection | 070.22, 070.23, 070.32, 070.33 | B18.1, B18.0 |
PEP | Contaminated needle stick | E920.5 | W46.1X |
Other specified prophylactic or treatment measure | V07.8 | Z29.89 | |
Unspecified prophylactic or treatment measure | V07.9 | Z29.9 | |
* ‘X’ denotes any letter(s) or number after the decimal point. |
Exclusionary Treatments
Treatment | Exclusion Items | GPI Codes* |
HIV treatment | Antiretrovirals | 1210xxx* (with the exception of Truvada [FTC/TDF], Descovy [FTC/TAF], and Apretude for PrEP) |
CHB treatment | Hepatitis B agents (e.g., adefovir, entecavir, lamivudine, telbivudine, TAF) | 123520xxx*† |
* ‘x’ denotes any number after the specified leading digits.
† The GPI code for Viread (TDF; 1210857010) is the same for the two approved HIV and HBV indications and is included within the HIV treatment era exclusions. |