Racial Disparities and Hospital Outcomes in Patients with HIV Undergoing Autologous Stem Cell Transplant. Analysis of the National Inpatient Sample (2016-2020)

Objective: Individuals with HIV are at a higher risk of developing hematological malignancies. Stem cell transplantation has demonstrated to be a safe and effective treatment for certain HIV patients that meet the criteria. This study reports racial disparities, demographic characteristics and hospital outcomes in HIV-positive vs non-HIV patients undergoing autologous stem cell transplant (ASCT), using data from the National inpatient sample (NIS) database from 2016 to 2020.

Methods: Data regarding patient's demographics, comorbidities and hospital outcomes was extracted from the national inpatient sample (NIS) database 2016-2020, using international classification of diseases (ICD) codes, for hospitalizations related to autologous bone marrow transplants in HIV patients. Multivariate regression analysis was used to calculate the adjusted odds ratio for the primary outcomes, adjusted for age, race, sex, comorbidities and payer.

Results: A total of 59,445 hospitalizations for ASCT were identified during the studied period, of which 59,155 were non-HIV patients and 290 were HIV positive patients. Despite the higher prevalence of HIV among African American individuals in the United States, this study showed significant racial disparities (p < 0.001), with only 25.86% of HIV-positive transplant recipients being African American compared to 46.55% White. HIV-positive patients were younger (median age 51 vs. 59 years, p < 0.001) and predominantly male (94.83% male vs. 59.52% male, p < 0.001). They also had higher rates of comorbid conditions, including liver disease (12.07% vs. 3.04%, p < 0.001), obesity (13.79% vs. 9.49%, p = 0.012), and pulmonary circulation disorders (3.45% vs. 1.57%, p = 0.011). The number of ASCT steadily increased from 2016-2020 for both HIV and non HIV patients. In HIV-positive patients, it went up from 35 in 2016 to 60 in 2020, while in non-HIV patients, it increased from 10,745 to 11,255. Among patients with HIV-associated lymphoma undergoing ASCT, non-Hodgkin lymphoma was the most common one (41.38% in HIV patients vs. 20.94% in non-HIV patients), followed by Hodgkin lymphoma (22.41% vs. 6.86%) and Burkitt lymphoma (10.34% vs. 0.08%). In-hospital mortality was higher for HIV-positive patients (aOR: 2.569, 95% CI: 1.316-5.015, p = 0.005), and they also experienced a significant higher rate of neutropenic fever (2.061, 95% CI: 1.627-2.612, p < 0.001). No significant difference was observed in the rates of mechanical ventilation (aOR: 0.652, 95% CI: 0.259-1.640, p = 0.3629), AKI (aOR: 1.176, 95% CI: 0.842-1.641, p = 0.3412), C. difficile infection (aOR: 0.556, 95% CI: 0.295-1.050, p = 0.0704), and VTE/PE (aOR: 0.575, 95% CI: 0.297-1.114, p = 0.1007) between HIV and non-HIV patients. HIV-positive patients had longer hospital stays (median 20 vs. 17 days) and higher hospitalization costs (median $83,168.99 vs. $53,963.52).

Conclusion: HIV positive patients undergoing autologous stem cell transplant are at higher risk of developing neutropenic fever and in-hospital mortality. Cost and length of hospitalization was also higher for HIV-positive patients. Additionally, there are significant racial disparities, with African American individuals having lower rates of ASCT despite representing a significant portion of the HIV-positive population.

No relevant conflicts of interest to declare.