Table 4 summarizes proposed methods to reduce lung cancer morbidity and mortality in patients with HIV. To curb the growing burden of lung cancer in the HIV population, it is essential that patients who are smokers be counseled aggressively for smoking cessation and treated for tobacco addiction with pharmacologic and nonpharmacologic interventions. Although smoking rates in the HIV-infected population are three to four times higher than those of the general population, successful rates of smoking cessation in the two groups are similar. With comprehensive intervention comprising nicotine replacement therapy, counseling, and follow-up, approximately 20% quit rates can be achieved. It is thus imperative that HIV care providers assess smoking status of their patients at least yearly and foster smoking cessation through education, counseling, and pharmacologic therapies. Smoking cessation reduces the risk of lung cancer mortality by > 50%.59 Because the stage of the tumor is the predominant driver of survival, early detection of lung cancer is desirable. Regrettably, however, > 80% of the cases are discovered in advanced stages, at which point cure is not possible. Plain chest radiograph is not a useful screening test for the detection of early lung cancer. Brock et al,20 for instance, found that in more than one-half of patients later given a diagnosis of lung cancer, chest radiographs did not demonstrate any suspicious lesions, even those that were done within 12 months of the diagnosis. Thus, chest radiographic screening for lung cancer cannot be advocated for patients with HIV infection. Of promise, the National Lung Screening Trial demonstrated a 20% mortality reduction from lung cancer and 7% total mortality reduction with annual thoracic CT screening in heavy former and current smokers.56 For individuals with HIV infection who meet the eligibility criteria for the National Lung Screening Trial (ie, aged 55-74 years, ≥ 30 pack-year smoking history, current or former smokers [quit smoking within 15 years]), annual screening with thoracic CT scans may be considered.60 However, the cost-effectiveness of this intervention is unknown. Thus, there is a pressing need to develop novel (cost-effective) strategies to address the epidemic of lung cancer in patients with HIV infection.