CAR-T clinical trials for non-Hodgkin lymphoma remain less accessible to people living with HIV, according to a new cross-sectional study that identified significant disparities in travel times and geographic access compared with the wider population.
Limited Inclusion In CAR-T Clinical Trials
Researchers analysed interventional CAR-T clinical trials for non-Hodgkin lymphoma listed on ClinicalTrials.gov that were actively recruiting adult participants in the contiguous United States as of May 2025. Of 254 eligible studies reviewed, 80 met inclusion criteria.
Among these 80 trials, only 11 (13.8%) explicitly included people living with HIV, while 58 (72.5%) excluded them and 11 (13.8%) did not mention HIV status in eligibility criteria. The study evaluated access by calculating population weighted travel times to the nearest trial site using geographical data from participating centres.
Longer Travel Times for People Living With HIV
The analysis revealed that people living with HIV faced significantly greater travel burdens when seeking access to CAR-T clinical trials. The median population weighted travel time for HIV inclusive trials was 1.15 hours, compared with 0.84 hours for trials excluding people living with HIV and 0.73 hours for the general trial population.
Access within 1 hour was substantially lower for HIV inclusive studies compared with HIV exclusive studies: 46.07% versus 55.27% (P<0.001). Similar disparities were observed for access within 3 hours: 82.22% versus 87.76% (P<0.001).
Regional Disparities Most Pronounced in The South
The greatest access gap was observed in the southern United States, a region with a high prevalence of HIV. In this area, the median travel time to the nearest HIV inclusive CAR-T clinical trial was 1.70 hours compared with 0.92 hours for HIV exclusive studies (P<0.001).
CAR-T therapy has transformed the treatment landscape for non-Hodgkin lymphoma, yet people living with HIV continue to encounter barriers to participation in clinical research. The findings suggest that efforts to reduce exclusion based solely on HIV status have not fully translated into equitable access to CAR-T clinical trials.
The authors concluded that additional strategies are needed to improve trial availability and participation opportunities for underserved populations, particularly people living with HIV, who remain underrepresented despite facing a substantial burden of lymphoma related mortality.
Reference
Maillie L et al. Geospatial access to CAR-T clinical trials for non-hodgkin lymphoma for persons with HIV. JAMA. 2026;9;(5):e2614265.
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