S3159 Inpatient Outcomes of Peptic Ulcer Disease in HIV-Positive Patients in the United States

Introduction: Peptic ulcer disease (PUD) remains a major cause of global morbidity and mortality, with annual deaths exceeding 250,000. In patients with human immunodeficiency virus (HIV), prior studies suggest a reduced incidence of PUD, likely due to lower gastric acid production and altered physiology. However, the burden of inpatient complications and outcomes in HIV-positive (HIV+) patients with PUD remains underexplored. This study evaluates the impact of HIV on PUD-related inpatient outcomes, complications, and healthcare resource utilization using national-level data. Methods: We conducted a retrospective analysis of the National Inpatient Sample (2016-2021), identifying adults hospitalized with PUD, stratified by HIV status. Multivariable logistic regression adjusted for age, gender, race, Elixhauser comorbidity index, insurance, hospital teaching status, and bed size. Outcomes included in-hospital mortality, complications, resource utilization, and procedures. Results: Among 200,830 patients with PUD, 835 (0.42%) were HIV+. HIV+ patients were younger (mean age: 56.3 vs 66.2 years), predominantly men (72.5% vs 52.1%; P < 0.001), Black (46.7% vs 13.1%), and on Medicaid (34.1% vs 12.7%; P < 0.001). HIV+ patients had higher rates of drug abuse (13.2% vs 4.0%; P < 0.001), and smoking (52.1% vs 39.5%; P < 0.001), but lower rates of hypertension (53.3% vs 66.1%; P < 0.001) and obesity (8.4% vs 15.7%; P < 0.001). Adjusted analyses showed significantly higher odds of in-hospital mortality (adjusted odds ratio [aOR] 2.34; 95% confidence interval [CI] 1.33-4.10; P = 0.003) and acute kidney injury requiring hemodialysis (aOR 1.97; 95% CI 1.18-3.27; P = 0.009) in HIV+ patients. Helicobacter pylori detection was markedly lower in HIV+ patients (aOR 0.19; 95% CI 0.05-0.75; P = 0.018). Adjusted costs were $35,099.28 higher (P = 0.025), and lengths of stay were 1.03 days longer (P = 0.189). Utilization of upper endoscopy and transfusion procedures were similar. Conclusion: HIV has been associated with a lower incidence of PUD due to reduced gastric acid production. Hospitalized HIV+ patients with PUD experience significantly worse outcomes with increased in-hospital mortality, higher likelihood of renal failure requiring hemodialysis, and prolonged hospital stay. The significantly lower odds of Helicobacter pylori detection suggest alternative ulcer etiologies such as medication-induced ulcers, opportunistic infections (e.g., cytomegalovirus), or non-H. pylori dyspepsia, underscoring the need for tailored diagnostic strategies.