S2006 Epidemiology and Clinical Outcomes of Inflammatory Bowel Disease in Patients With and Without HIV: A 15-Year Study Using the National Inpatient Sample Database

Introduction: Inflammatory bowel disease (IBD) is a chronic gastrointestinal disease with a rising prevalence and significant impacts on quality of life and healthcare systems. With improved survival due to antiretroviral therapy, people living with HIV increasingly present with chronic comorbidities, including IBD. However, the clinical interaction between IBD and HIV remains poorly understood due to their opposing immunologic mechanisms. This study analyzes National Inpatient Sample (NIS) data to compare the prevalence, trends, and in-hospital outcomes of IBD among HIV-positive vs HIV-negative patients. Methods: We conducted a retrospective cohort study using NIS data (2008-2022), identifying adults hospitalized with IBD via International Classification of Diseases-10 and International Classification of Diseases-9 codes. The primary aim was to compare prevalence and baseline demographic characteristics of IBD among HIV-positive and negative patients. Secondary outcomes included in-hospital mortality, length of stay (LOS), gastrointestinal and extraintestinal complications. Multivariable logistic regression was adjusted for relevant demographic and clinical covariates. Results: We analyzed 16,820 propensity-score matched hospitalized IBD patients. IBD prevalence was lower among HIV-positive patients (6,079) compared to HIV-negative patients (10,741). Baseline demographics were similar, though diabetes was slightly more common in HIV-negative patients (30.4% vs 28.7%, P = 0.025), and alcohol use was higher in HIV-positive patients (8.6% vs 7.7%, P = 0.038). HIV-positive patients had significantly fewer intestinal complications (P < 0.05), including rectal bleeding (3.4% vs 7.2%), obstruction (3.8% vs 5.9%), fistula (1.8% vs 3.6%), abscess (1.5% vs 2.5%), perforation (0.35% vs 0.74%), as well as lower malnutrition rate (10.2% vs 11.8%). However, the differences in mortality, sepsis, acute kidney injury, and thromboembolic events among both groups were non-significant. Besides, HIV-positive patients had longer LOS (median 5 vs 4 days, P < 0.001). Multivariable analysis confirmed lower odds of GI complications and malnutrition but a 16.1% longer LOS in HIV-positive patients (aOR 1.16, P < 0.001). Conclusion: HIV-positive hospitalized IBD patients demonstrated lower gastrointestinal complication rates but had significantly longer hospital stays compared to HIV-negative patients. These findings suggest a distinct clinical profile in HIV-positive IBD patients, warranting further investigation into underlying immunologic and treatment-related factors.