SO-2 Pancreatic cancer in HIV versus non-HIV population: Analysis of demographics, outcomes and healthcare utilization from a national sample

Abstract

Pancreatic cancer (PC) is a highly fatal cancer with a dismal 5-year overall survival. With the advent of combined antiretroviral therapy, the lifespan of HIV patients has substantially improved and the incidence of non-AIDS-defining cancer is rising. PC remains rare in HIV and there is very little data about outcomes of PC in HIV versus non-HIV patients. We attempted to evaluate characteristics and outcomes, including healthcare utilization (HU), in patients with HIV-PC compared to non-HIV-PC using a national sample. United States Healthcare Cost and Utilization Project's National Inpatient Sample (HCUP-NIS) (>7 million discharges/year) was queried to identify HIV and non-HIV-PC admissions between 2016-2018. We studied socio-demographic differences, medical comorbidities, mortality, length of stay (LOS), total hospital charges (THC). Secondary outcomes included sepsis, septic shock, neutropenia, anemia and malnutrition. Statistics were performed using the t-test, univariate and multinomial logistic regression. A total of 775 HIV-PC admissions and 317,415 non-HIV-PC admissions were identified, HIV-PC comprised 0.24% of all PC admissions. HIV-PC patients were significantly younger (mean age 59.9 vs 68.1, p<0.001) compared to non-HIV-PC. Proportion of patients over 65 years old was only 29.7% in HIV-PC group compared to 63.3% in non-HIV-PC group. HIV-PC patients were more likely to be men (71% vs 52%, p<0.0001), Black (52% vs 14%, p<0.0001), and less likely Caucasian (34% vs 71%, p<0.0001) compared to non-HIV-PC. HIV-PC were more likely to be treated at an urban teaching hospital (84.5% vs 76%, p=0.047) compared to non-HIV-PC but there was no difference in treating hospital bed size or zip-codes divided by income levels where patients hailed from. HIV-PC patients were less likely to be on private insurance and more likely to be on governmental sponsored insurance (p<0.001). The groups had similar rates of medical comorbidities including diabetes, CAD, COPD, heart failure, obesity and smoking. The HIV-PC group had significantly higher rates of chronic kidney disease (19% vs 12%, p=0.012) and dialysis (4.5% vs 0.86%, p<0.001) while non-HIV-PC showed higher rates of dyslipidemia (36% vs 25%, p=0.01) and hypertension (48% vs 39%, p=0.045). HIV-PC patients were also more likely to be malnourished (42% vs 34%, p=0.04) compared to non-HIV group. Rates of anemia, neutropenia, thrombocytopenia and sepsis were similar between groups. The mean LOS was higher in HIV-PC group (7.5 vs 6.1 days, p=0.001), THC were higher in HIV-PC group ($80,141 vs $66,361, p=0.02) but both differences were not significant when adjusted for patient and hospital demographics. A total 9% HIV-PC and 7.6% non-HIV-PC group died during hospitalization. While crude mortality was non-significant between groups, adjusted OR for mortality (aOR) was 0.43 (95%CI 0.24-0.76, p=0.004) when adjusted for patient demographics, hospital demographics and medical comorbidities. Pancreatic cancer occurred at a significantly younger age in HIV-PC patients compared to non-HIV-PC patients. Racial disparity followed the same trend as general HIV-infection. Adjusted mortality was lower in HIV-PC while most medical comorbidities, secondary outcomes and adjusted healthcare utilization was not significantly different between HIV and non-HIV groups with PC. HIV-positive status does not add significantly to the medical burden in patients with pancreatic cancer.