Plate Nº 43 · recorded October 10, 2026
Health & Medicine ResearchReported finding
Only 14% of U.S. CAR-T trials accept HIV-positive cancer patients
Only 11 of 80 U.S. CAR-T clinical trials for non-Hodgkin lymphoma accept people with HIV, a new geospatial analysis finds. In the South, the median trip to an inclusive trial takes 1.70 hours.
By Marcus Bennett3 min read624 words
In brief
- 11 of 80 U.S. CAR-T trials for non-Hodgkin lymphoma (13.8%) include people with HIV, while 58 (72.5%) explicitly exclude them.
- 62% of CAR-T clinical trials have historically excluded people living with HIV.
- Median travel time to an HIV-inclusive trial is 1.15 hours nationally, versus 0.84 hours to an excluding trial.
- In the U.S. South, the median travel time to an inclusive trial reaches 1.70 hours, nearly double the 0.92-hour trip to an excluding trial.
- Study published in JAMA Network Open, DOI: 10.1001/jamanetworkopen.2026.14265, co-led by Matthew Sisk (Notre Dame) and Dr. Luke Maillie (University of Pennsylvania).
Only 11 of 80 U.S. CAR-T clinical trials for non-Hodgkin lymphoma (13.8%) accept people with HIV, while 58 explicitly exclude them, according to a multi-institutional study published in JAMA Network Open.
The geospatial analysis, co-led by researchers at the University of Notre Dame and the University of Pennsylvania, quantifies a barrier long suspected but rarely mapped: where a patient lives can determine whether a cutting-edge cancer therapy is even within reach.
Why does eligibility matter for CAR-T?
CAR-T therapy engineers a patient's own T-cells to recognize and destroy cancer cells. The treatment transformed care for relapsed or refractory non-Hodgkin lymphoma (NHL), a cancer that remains a leading cause of death among people living with HIV.
Yet 62% of CAR-T trials have historically excluded HIV-positive participants, despite the therapy's potential to target cancer cells without worsening HIV infection.
How did the team measure access?
The researchers, led by Matthew Sisk of Notre Dame's Civic-Geospatial Analysis and Learning Lab (C-GALL) and Dr. Luke Maillie, a hematology-oncology fellow at Penn, pulled every NHL-focused CAR-T trial from the NIH clinical trials database. They identified 80 interventional studies with at least one U.S. site.
Of those trials:
- 11 (13.8%) included people with HIV
- 58 (72.5%) explicitly excluded them
- 11 made no mention of HIV in their eligibility criteria
They then calculated driving times from population centers to the nearest trial site using geospatial methods that map how distance and accessibility vary across regions.
What did the analysis find nationally?
The median travel time for an HIV-positive patient to the nearest inclusive trial was 1.15 hours, compared with 0.84 hours to a trial that excluded them, a difference of roughly 19 minutes.
Lower household income tracked with longer travel times across every region studied. Access to inclusive trials lagged across nearly all racial, ethnic, and insurance categories as well.
Why is the South the hardest hit?
In the U.S. South, home to the country's largest HIV population, the gap widens sharply. The median trip to an HIV-inclusive trial reached 1.70 hours, nearly double the 0.92-hour drive to a trial that excluded HIV-positive patients.
"We know that generally there is a link between longer travel times to care and poor health outcomes," Sisk said. "Our goal was to apply geospatial analysis to investigate how much more difficult it is for individuals with HIV to reach the nearest clinical trial than the general population."
What could shrink the gap?
Sisk and Maillie point to two levers: rewriting eligibility rules, and bringing trials closer to patients.
"Expanding HIV-inclusive eligibility criteria and increasing access through decentralized trial sites or partnerships between academic and community centers could help reduce these barriers," Sisk said, "and ensure that this population has more equitable access to emerging CAR-T therapies."
"Access to clinical trials for CAR-T therapy is particularly important for people living with HIV," Maillie added, "who face higher cancer mortality rates than people without HIV and for whom NHL remains a leading cause of cancer-related death."
What are the study's limits?
The analysis draws on the NIH registry, which may not capture every active trial. It measures proximity, not enrollment or completion, and excludes patients who never enter the database. Trials that formally exclude HIV-positive patients sometimes grant waivers case by case, a flexibility the dataset cannot record.
The study, published in JAMA Network Open (DOI: 10.1001/jamanetworkopen.2026.14265), drew on collaborators from the H. Lee Moffitt Cancer Center, Virginia Mason Medical Center, the University of Washington Positive Research, and Memorial Sloan Kettering Cancer Center.
via Medical Xpress (Source)
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