Lung Cancer Screening Lags for People With HIV as Eligibility Triples

Fewer than 3 in 10 people living with HIV (PWH) who met lung cancer screening criteria at a Southeastern HIV clinic ever underwent a scan, even as eligibility nearly tripled between 2018 and 2023, according to a recent study published in International Journal of STD & AIDS.¹

Smoking, Aging, and an Underused Benefit

Lung cancer is now the leading cause of cancer death among PWH in the US, a shift driven by antiretroviral therapy that has extended life expectancy and allowed non–AIDS-defining malignancies to emerge as dominant mortality drivers. Annual low-dose CT screening can reduce lung cancer mortality, and the US Preventive Services Task Force (USPSTF) broadened its eligibility criteria in 2021 to adults aged 50 to 80 years with a 20-pack-year smoking history who currently smoke or quit within the past 15 years—criteria not adjusted specifically for HIV status.² Whether that benefit is reaching PWH, who have disproportionately high rates of smoking, has not been well characterized.

Researchers at a tertiary HIV clinic in the Southeastern US set out to measure how many PWH in their care met screening criteria over time and how many actually completed a scan, tracking 6 annual snapshots from 2018 through 2023.¹

A 6-Year Look at One HIV Cohort

Data were gathered from a cross-sectional analysis of PWH engaged in care at the center, drawing on electronic health records, clinical event adjudications, and patient-reported outcomes at 6 time points corresponding to each calendar year. Among 2798 PWH in care, 74% were men, 57% identified as non-Hispanic Black, and the median (IQR) age was 48 years (35-57). Smoking was common: 62% of the cohort had a smoking history, with a median 40 pack-years (27-50), and 51% of those with a smoking history were current smokers.

Prevalence differences and 95% CIs were estimated across demographic and clinical subgroups to characterize both eligibility and uptake trends across the study period.

The proportion of PWH meeting USPSTF screening criteria more than doubled, rising from 6% in 2018 to 15% by 2023 (P < .05). Across the full study period, 13% of PWH were eligible for screening at some point, yet less than one-third of those individuals (27%) ever received a scan during follow-up. Annual screening rates moved from 11% in 2018 to 24% in 2023, a trend that did not reach statistical significance (P = .10).

“Lung cancer screening utilization remains low, even among a high-risk population in the Southeastern United States,” the researchers wrote. Understanding the specific barriers to screening, they added, is needed to improve lung cancer outcomes for this population.

Single-Center Data With a Clear Message

The analysis drew on PWH engaged in care at a single tertiary academic center, which may limit how broadly the findings generalize to community HIV clinics or regions with different demographic profiles. The modest absolute number of eligible patients each year also limited statistical power to detect smaller changes in annual screening rates.

Even with those constraints, the consistency of the gap between eligibility and completed screening, observed across all 6 years studied, points to a utilization problem rather than a measurement artifact.

For clinicians and payers alike, the findings argue for building lung cancer screening prompts directly into routine HIV care visits, given how often this population already engages with the health system for antiretroviral management. Patient navigation and reminder systems embedded in HIV primary care, the authors suggested, may be needed to close a gap that otherwise persists even as more patients become eligible each year.

References

1. Sellers SA, Browne LE, Henderson HI, et al. Lung cancer screening among people with HIV, 2018-2023. Int J STD AIDS. 2026;37(10):1086-1094. doi:10.1177/09564624261469254
2. US Preventive Services Task Force. Screening for Lung Cancer: US Preventive Services Task Force Recommendation Statement. JAMA. 2021;325(10):962-970. doi:10.1001/jama.2021.1117