A nationwide analysis of outcomes and healthcare utilization in HIV versus non-HIV patients with colon cancer.
Authors: Sherazi Syed Ali Amir , Achebe Ikechukwu , Alkaddoumi Yaseen , Asotibe Jennifer C , Attar Bashar , Gupta Shweta , Mullane Michael Russell 
Published: June 2021

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Background: The incidence and mortality of Colon cancer (CC) is reportedly similar in HIV and non-HIV populations with same screening guidelines. The pathogenesis of HIV-CC may be multifactorial; related to chronic inflammation from AIDS colopathy, 2-fold increase in risk of polyps, smoking, elevation in proinflammatory cytokines, decrease in adiponectin, activation of b-catenin signaling pathway all of which may promote neoplastic growth of colonic mucosa. With increasing survival in HIV due to effective antiretroviral therapy, non-AIDS defining cancers are rising as population ages. We attempted to compare demographics and outcomes of HIV and non-HIV-CC patients in a national database. Methods: Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS) was queried to identify all HIV and non-HIV-CC admissions. The groups were compared for socio-demographic differences, medical comorbidities, inpatient mortality, length of stay (LOS) and hospital charges (THC). Secondary outcomes studied included rates of sepsis, septic shock (SS), Anemia, transfusions, GI bleeding, colostomy rates, Acute Kidney Injury (AKI) and protein energy malnutrition (PEM). Statistics were performed using t-test, univariate and multinomial logistic regression. Results: A total 895 HIV-CC and 514,840 non-HIV-CC admissions were identified. HIV-CC were younger (mean age 56.3 vs 67.3 years, p < 0.001) with 76% < 65 years old compared to 40% in non-HIV-CC. HIV-CC were more likely male (75.4% vs 50.5%, p < 0.001), African Americans (AA) (43% vs 14%, p < 0.001) and Hispanic (19% vs 9%, p < 0.001), were more likely from lowest income quartile zip codes (44% vs 28%, p < 0.001) from the Northeast region of US (27% vs 19%, p < 0.001) and on Medicaid (30% vs 10%, p < 0.001). HIV-CC had significantly lower rates of medical comorbidities (hypertension, diabetes, obesity, dyslipidemia, heart failure, all p < 0.05) compared to non-HIV-CC. The odds of adjusted inpatient mortality were significantly lower in HIV-CC (aOR = 0.46 CI = 0.24-0.87, p = 0.018), however HIV-CC had longer mean LOS (8.17 vs 6.66 days, p < 0.01) and higher mean THC ($88,305 vs $76,317, p = 0.051). Cancer pain and PEM were significantly higher in the HIV-CC group, but other secondary outcomes were similar. Conclusions: HIV-CC patients were significantly younger and minorities with significantly lower all-cause mortality compared to non-HIV-CC. The lower mortality may be explained by younger age, treatment of teaching hospitals for HIV-CC and lower incidence of medical comorbidities which may be driving mortality higher in non-HIV-CC. However, healthcare utilization of HIV-CC was higher with over $10 million in extra charges in 3 years compared to non-HIV-CC. The young age of HIV-CC compared to non-HIV suggests a need for studies to evaluate the role of starting colon-cancer screening at a younger age in the HIV population.