Treatment disparities in acute leukemia among patients with HIV: A nationwide analysis

Abstract Treatment Disparities in Acute Leukemia Among Patients With HIV: A Nationwide Analysis Background Leukemia and HIV individually involve complex treatment protocols, but their co-occurrence presents distinct clinical challenges. Existing literature suggests that patients with HIV are less likely to receive standard cancer treatment. This study aimed to investigate inpatient treatment disparities for patients with leukemia and HIV using a nationally representative database. Methods We conducted a retrospective analysis using the National Inpatient Sample (NIS) database from 2016 to 2020. All hospitalizations of patients with acute leukemia were identified using ICD-10 codes. From this cohort, patients with asymptomatic HIV were identified using ICD-10 code Z21 and compared with HIV-negative patients. Baseline demographics (age, gender, race, primary payer, Charlson Comorbidity Index [CCI]), treatment modalities (chemotherapy, allogeneic transplant), and clinical outcomes (sepsis, length of stay [LOS], total charges, mortality) were analyzed. Chi-squared tests were used for categorical variables and independent sample t-tests for continuous variables, with significance set at p < 0.05. Results Of the 618,590 weighted hospitalizations analyzed, 730 involved patients with HIV and 617,860 did not. The HIV-positive cohort was significantly older (52.99 vs 45.75 years, p<.001), had fewer females (32.2% vs 44.3%, p<.001), and a higher proportion of Black patients (34.9% vs 9.3%, p<.001). HIV-positive patients were more likely to be on Medicaid (28.1% vs 22.5%) and self-pay (4.8% vs 2.5%) insurance plans. Comorbidity burden (CCI) was similar between groups (4.4 vs 4.3, p=0.300), though HIV-positive patients had a longer length of stay (12.3 vs 11.0 days, p=0.01). HIV-positive patients were significantly less likely to receive chemotherapy (30.1% vs 42.3%, p<.001) but more likely to undergo allogeneic transplant (6.2% vs 3.4%, p<.001). There was no significant difference in total hospital charges ($165,025 vs $152,469, p=0.17), rates of sepsis (13.7% vs 15.5%, p=0.17), or in-hospital mortality (6.2% vs 6.0%, p=0.82). Conclusion Despite similar comorbidity burden and clinical outcomes (including rates of sepsis and mortality), HIV-positive leukemia patients were significantly less likely to receive chemotherapy. Interestingly, allogeneic transplant rates were higher among HIV-positive patients, which may reflect a greater prevalence of adverse-risk leukemia in this group. These findings highlight potential disparities in leukemia treatment for HIV-positive patients and underscore the need for protocols that ensure equitable access to standard cancer therapies regardless of HIV status.