HIV positive cancer patients in the US face a tougher road to CAR-T therapy. The distance is not just medical. It is literal. A new multi-center study now puts numbers to the extra miles these patients must cover for a shot at clinical trials. The gap is wide.
Researchers from the University of Notre Dame's Civic-Geospatial Analysis and Learning Lab (C-GALL) worked with teams at the University of Pennsylvania, H. Lee Moffitt Cancer Center and Research Institute, Virginia Mason Medical Center, University of Washington Positive Research, and Memorial Sloan Kettering Cancer Center. They mapped out the real barriers for people living with HIV who want to join CAR-T trials for non-Hodgkin lymphoma (NHL). The results show a double hit. Many HIV positive patients are blocked from trials. Even when allowed, they often have to travel much farther than others.
In a recent review of CAR-T clinical trial protocols, HIV status was frequently listed alongside hepatitis B, hepatitis C, and active infections as grounds for exclusion, reflecting ongoing safety concerns in patient selection.
Matthew Sisk of C-GALL and Luke Maillie, M.D. of the University of Pennsylvania led the study. Their team used geospatial analysis to lay bare the inequities. They checked the National Institutes of Health’s clinical trials database. The median travel time for HIV positive patients to the nearest trial that would accept them was 1.15 hours. For trials that excluded them, the median was just 0.84 hours. The South stands out. There, where HIV rates are highest, the gap grows: 1.70 hours for inclusive trials, 0.92 hours for those that exclude.
Of 80 adult CAR-T trials with at least one US site, only 11 (13.8 percent) included people living with HIV. Most—58 trials, or 72.5 percent—explicitly excluded them. Another 11 did not mention HIV status in their rules. This is not just paperwork. It means less access for a group already facing higher cancer death rates. NHL is still a top cause of cancer death for people with HIV.
Access to HIV-inclusive trials was lower for nearly every racial and ethnic group, income bracket, insurance type, and region. Lower household income made things worse. Poorer patients had to travel even farther to reach a trial site. Sisk summed it up: “Expanding HIV-inclusive eligibility criteria and increasing access through decentralized trial sites or partnerships between academic and community centers could help reduce these barriers and ensure that this population has more equitable access to emerging CAR-T therapies.”
Recent independent reviews of CAR-T and immunotherapy protocols confirm that HIV positive status is still commonly used as an exclusion criterion, even in studies that also list hepatitis B, hepatitis C, and other infectious risks. This pattern highlights the persistent reliance on infection-related safety profiles in trial design.
Ahmed Abbasi of the Lucy Family Institute for Data & Society pointed out that geospatial data can reveal gaps that raw numbers miss. The C-GALL team’s mapping approach puts a human face on the problem. It shows where and how barriers to care show up. This echoes the kind of targeted focus seen in reported earlier efforts to attack cancer’s weak spots.
The takeaway is blunt. This is not just a numbers game. The ongoing exclusion of people living with HIV from CAR-T trials, plus the extra miles even when they are allowed in, points to a system that is not delivering on the promise of precision medicine. Unless sponsors and research centers fix both the rules and the reach, the best therapies will stay out of reach for those who need them most. The evidence is on the table. Equity in clinical research is not just a goal. It is a gap that can be measured—and closed.
