Impact of HIV status on clinical outcomes in Hodgkin lymphoma: A national database study

Abstract

Abstract Background: Patients with Human Immunodeficiecy Virus (HIV) are at increased risk for Hodgkin Lymphoma (HL). Real world outcomes in this special population in the current cART (combined antiretroviral therapy) era are favorable (Navarro JT et al., Cancers 2021). We evaluated the characteristics, outcomes, and healthcare utilization of patients with HL with and without HIV. Methods: We queried Healthcare Cost and Utilization Project- National Inpatient Sample to identify adult patients hospitalized with HL from 2016-2020. Patients were stratified by their HIV status. Cohorts were analysed to assess differences in sociodemographic variables, comorbidity profiles, inpatient mortality, length of stay (LOS), and total hospital charges (THC) as the primary outcomes. Secondary outcomes included incidence of sepsis, respiratory failure, intubation, acute kidney injury (AKI), pressor use, pulmonary embolism, pneumonia, Urinary tract infection, neutropenia, blood transfusion and Pneumocystis jirovecii pneumonia (PJP). Statistics were performed using t-test, univariate and multinomial logistic regression. Results: HIV-HL patients were mostly in the middle age group (45-65yrs) (53.5 vs 30%) than non-HIV-HL who were younger <45yrs (38.7 vs 39.5%)(all p < 0.001). HIV cohort had a higher proportion of males (79.4% vs. 55.1%), Black patients (46.9% vs. 12.9%), Hispanics (24% vs. 12.3%), patients on Medicaid (33.8% vs. 18.2%) or uninsured (7.1% vs. 3.5%), were more often treated at non-teaching hospitals (88.3% vs. 81%), and were more likely to be in the lower income quartile (48.6% vs. 25.6%) (all p < 0.001). HIV-cohort had a significantly higher comorbidity burden, coinfection with Hepatitis B/C, on hemodialysis whereas non-HIV cohort had higher rates of dyslipidemia, cardiac diseases and obesity (all p, 0.05). The overall adjusted all-cause mortality was not significantly different between the study groups (aOR = 1.25, 95% CI 0.86-1.80, p = 0.23), however on subgroup analysis mortality was significantly increased for those on Medicaid (aOR = 1.57, 95% CI 1.18-2.07, p = 0.002) and uninsured patients (aOR = 1.66, 95% CI 1.01-2.75, p = 0.05) compared to patients with Medicare. Mean LOS (9 vs 7 days, 95% CI 1.00-1.19, p = 0.05) was similar between cohorts. THC was higher in HIV-HL, but not statistically significant ($100,428 vs $91,939, p = 0.172). Secondary outcomes like PJP infection (aOR = 6.91 95% CI 3.46-13.80, p < 0.001), neutropenia (aOR = 1.58, 95% CI 1.26-1.98, p < 0.001), acute kidney injury (aOR = 1.28, 95% CI 1.04-1.57, p = 0.02) and sepsis (aOR = 1.64, 95% CI 1.30-2.06, p < 0.001) were significantly higher in HIV-HL group (all p<0.05). Conclusion: HIV-HL patients were older, mostly in the middle age, while non-HIV patients were younger (<45 years). HIV-HL patients were more likely to be in the lower income quartile. Although overall mortality and outcomes were similar between the groups, an economic disparity was seen with higher mortality in Medicaid and uninsured patients, the cause of which should be investigated.