OBJECTIVES: Although human immunodeficiency virus (HIV)-Infected patients are now living longer, there are no published data on colorectal cancer (CRC) screening in this population. We hypothesized that HIV-infected patients were less likely to be screened for CRC compared to patients without HIV. METHODS: Consecutive HIV-infected patients ≥50 yr old seen in our outpatient clinic from 1/1/01 to 6/30/02 were identified. For each HIV-infected patient, we selected one age- and gender-matched control subject without HIV infection who was seen during the same time period. The electronic medical records were reviewed to determine the proportion of patients that had a fecal occult blood test (FOBT), flexible sigmoidoscopy, air-contrast barium enema (ACBE), or colonoscopy. RESULTS: During the 18-month study period, 538 HIV-infected outpatients were seen and 302 (56.1%) were ≥50 yr old. Despite significantly more visits with their primary care provider, HIV-infected patients were less likely to have ever had at least one CRC screening test (55.6% vs 77.8%, p < 0.001). The proportion of HIV-infected patients who ever had a FOBT (43.0% vs 66.6%, p < 0.001), flexible sigmoidoscopy (5.3% vs 17.5%, p < 0.001), ACBE (2.6% vs 7.9%, p = 0.004), or colonoscopy (17.2% vs 27.5%, p = 0.002) was significantly lower than in control subjects. In addition, HIV-infected patients were significantly less likely to be up-to-date with at least one CRC screening test according to current guidelines (49.3% vs 65.6%, p < 0.001). CONCLUSIONS: A substantial number of HIV-infected patients are ≥50 yr of age and CRC screening is underutilized in this population. Public health strategies to improve CRC screening in HIV-infected patients are needed.