As people living with HIV (PLWH) benefit from longer life expectancy due to antiretroviral therapy, a new threat is emerging—lung cancer is now one of the leading causes of death in this population. The reasons are complex: PLWH are twice as likely to smoke, face higher cancer risk at younger ages, and experience immunosuppression and chronic inflammation that compound risk.
Addressing a Silent Crisis
Dr. Subhashini Sellers, MD, MSCR, assistant professor in pulmonary critical care at UNC, led a study supported by a CFAR Developmental Award examining lung cancer screening eligibility and uptake among PLWH at UNC Health. She presented the findings at a recent UNC Friday Conference.
Screening Saves Lives—But Access Falls Short
The U.S. Preventive Services Task Force (USPSTF) recommends lung cancer screening using low-dose CT scans for adults aged 50–80 with a significant smoking history. In 2021, these criteria expanded to include individuals with at least a 20-pack-year smoking history. Yet PLWH were not considered in the original models or guidelines.
Currently, only 3–5% of eligible individuals in the general population are being screened—and among PLWH, adherence is even lower.
Key Findings from UNC Health
Dr. Sellers’s team reviewed health data from 7,000 PLWH receiving care at UNC Health, analyzing demographics, HIV markers, substance use history, and lung cancer screening data from 2014–2023. Key findings included:
- In 2014, only 9% of eligible patients were screened.
- By 2023, screening rates improved to 29%, but large gaps remain.
- Black and Hispanic patients, uninsured individuals, and those with low CD4 counts or higher viral loads were less likely to meet screening eligibility or be screened.
What’s Next?
Future analysis will examine adherence patterns, such as the time from eligibility to first CT scan and annual follow-ups. The research aims to inform tailored interventions for PLWH, including:
- Patient outreach and navigation
- Health system optimization
- Reducing barriers specific to HIV care and stigma
A Life Saved
Dr. David Margolis, the CFAR Co-Director, shared a powerful story: one of his HIV patients was identified for screening, underwent a CT scan, and was diagnosed with early-stage lung cancer. The patient received life-saving surgery. To read more about Dr. Sellers’s study on UNC’s Institute for Global Health’s website click here.