Treatment Disparities in Acute Leukemia Among HIV-positive Patients: Evidence from a Comprehensive National Study

Leukemia and HIV individually involve complex treatment protocols; however, their co-occurrence presents distinct clinical challenges. This study aimed to investigate inpatient treatment disparities for patients with leukemia and HIV using a nationally representative database.

We performed a retrospective analysis of the National Inpatient Sample from 2016 to 2020. Hospitalizations for acute leukemia were identified using ICD 10 codes, and patients with asymptomatic HIV (Z21) were compared with HIV negative patients. Baseline demographics, treatment patterns, and clinical outcomes were evaluated using chi squared tests for categorical variables and independent sample t tests for continuous variables, with significance of p<0.05.

HIV positive patients were older, less often female, and more frequently Black. They were more likely to have Medicaid (28.1% vs. 22.5%) or self-pay insurance (4.8% vs. 2.5%). Charlson Comorbidity Index (CCI) was similar (CCI 4.4 vs. 4.3, p=0.300), but length of stay was longer in the HIV positive group (12.3 vs. 11.0 days, p=0.01). HIV positive patients were less likely to receive chemotherapy (30.1% vs. 42.3%, p<0.001) yet more likely to undergo allogeneic transplant (6.2% vs. 3.4%, p<0.001). Total hospital charges, sepsis rates, and in-hospital mortality were comparable between groups.

Despite similar comorbidity burden and clinical outcomes, HIV positive leukemia patients were significantly less likely to receive chemotherapy. Higher allogeneic transplant rates may reflect a greater prevalence of adverse risk disease. These findings highlight treatment disparities and emphasize the need for protocols ensuring equitable access to standard cancer therapies regardless of HIV status.