Cannabis for Symptom Relief in HIV and Cancer: A Map of What We Know and What We Don’t

A scoping review of 51 observational studies reveals major gaps in evidence on cannabis dosing, effectiveness, and safety for symptom management in people living with HIV and cancer, with no research at all addressing the growing population living with both conditions simultaneously.

Why This Matters

People living with HIV and cancer often carry heavy symptom burdens, including chronic pain, fatigue, sleep disruption, and mood disturbance, and many turn to cannabis for relief. As medical cannabis legalization expands across jurisdictions and the American Nurses Association formally recognizes cannabis nursing as a specialty, clinicians urgently need a clear picture of what the observational evidence actually supports. This review arrives at a moment when patient demand for guidance is outpacing the evidence available to inform it.

Clinical Summary

Cannabis use for symptom management in HIV and cancer populations has grown substantially alongside expanding legalization, yet the evidence base informing clinical decisions has not been systematically mapped for observational research. A scoping review by Kates and colleagues, published in the Journal of the Association of Nurses in AIDS Care in 2025 and conducted following the PRISMA-ScR framework, examined quantitative observational studies from 2017 to 2022 across four major databases. The review’s focus on observational designs was deliberate: the authors sought to characterize real-world cannabis use patterns, symptom management outcomes, and gaps in the literature that could inform future research directions and clinical practice, particularly within the emerging cannabis nursing specialty.

The review retained 51 studies, 37 of which were cross-sectional. Individual studies reported associations between cannabis use and perceived symptom relief for pain, sleep, anxiety, and nausea in both HIV and cancer populations. Some HIV-specific studies found positive associations between cannabis use and antiretroviral therapy adherence or undetectable viral load. However, most studies lacked standardized measures of cannabis dose, delivery route, or perceived effectiveness, and relied on self-reported outcomes. No studies examined people living with comorbid HIV and cancer, despite this being a growing population with overlapping symptom burdens. The authors conclude that longitudinal designs with validated symptom measures and dose-response data are needed before clinical or policy recommendations can be responsibly advanced.

Dr. Caplan’s Take

This review does something genuinely useful: it shows us exactly how little structured evidence we have to work with, which is an honest and necessary contribution. Patients living with HIV and cancer frequently ask about cannabis for symptom management, and the answer they deserve is not a shrug but a frank acknowledgment that while biological plausibility exists and patient-reported experiences are real, the current observational data are too fragmented in their measurement of dose, delivery, and outcomes to guide confident recommendations. That gap between patient expectation and clinical evidence is where most of the difficulty lives.

In practice, I approach these conversations by acknowledging what patients are experiencing and what the literature does and does not support. I take a careful medication interaction history, particularly for patients on antiretroviral therapy or active cancer treatment, and I ensure they know that self-directed dosing guided by friends or the Internet carries real uncertainty. Where cannabis use is already occurring, I try to bring it into the clinical conversation rather than leaving it outside it, and I document it. That is the defensible path until better evidence arrives.

Clinical Perspective

This scoping review sits at the very early stages of the research arc for cannabis in these populations. It confirms that observational research exists in meaningful volume but reveals that the quality and consistency of measurement across studies are insufficient to support clinical guidance. The dominance of cross-sectional designs means that no causal inferences can be drawn about whether cannabis use actually improves symptoms or merely co-occurs with patterns of self-management. The complete absence of research on the comorbid HIV-cancer population is a significant blind spot, given that cancer is now a leading cause of morbidity and mortality among people living with HIV on effective antiretroviral therapy.

Clinicians should be attentive to pharmacological interactions between cannabis, particularly THC-dominant products, and commonly used medications in these populations. Cytochrome P450 interactions with certain antiretrovirals, chemotherapeutic agents, and supportive medications such as antiemetics and anxiolytics remain inadequately characterized in formal studies. Patients are often not disclosing cannabis use to their providers, and the review found that information sources are predominantly informal. One concrete, actionable step clinicians can implement now is to routinely and nonjudgmentally ask about cannabis use during symptom management discussions, document what patients report, and flag potential drug interaction concerns for pharmacy review.

Study at a Glance

Study Type

Scoping review (PRISMA-ScR)

Databases Searched

PubMed, PsycInfo, CINAHL, Embase

Publication Window

2017 to 2022

Abstracts Screened

1,738

Full Texts Reviewed

142

Studies Retained

51 (37 cross-sectional, remainder cohort and case-control)

Population

Adults with HIV or cancer; no studies on comorbid HIV and cancer

Geographic Focus

Predominantly United States (39 of 51 studies)

Primary Outcomes

Cannabis use patterns, symptom management (pain, sleep, anxiety, nausea), dosing, and delivery mode

Journal

Journal of the Association of Nurses in AIDS Care

Year

2025

Funding Source

NIAAA and NIH

What Kind of Evidence Is This

This is a scoping review conducted according to the PRISMA-ScR framework, designed to map the breadth and nature of existing observational research rather than to synthesize effect sizes or formally grade evidence quality. Scoping reviews sit below systematic reviews and meta-analyses in the evidence hierarchy. The most important inference constraint is that because no formal risk-of-bias assessment was performed and the underlying studies are overwhelmingly cross-sectional, neither the review nor its source studies can establish whether cannabis causes symptom improvement in these populations.

How This Fits With the Broader Literature

This review builds on a prior scoping review by the same research group covering the literature before 2017 and extends the evidence map into a period of rapidly expanding cannabis legalization. Its findings are broadly consistent with other reviews in the field, including the 2017 National Academies report, which found moderate evidence for cannabinoids in chemotherapy-induced nausea and chronic pain but noted major gaps in dose-response data and safety monitoring. The identification of an evidence void around comorbid HIV and cancer is a novel and clinically important contribution that prior reviews had not explicitly examined.

The geographic concentration of the evidence base in the United States limits generalizability to health systems with different regulatory environments, cannabis product availability, or patient demographics. The review’s emphasis on the cannabis nursing specialty also positions it within a specific professional literature that may not be widely accessed by oncologists, infectious disease specialists, or primary care physicians managing these patients.

Common Misreadings

The most likely overinterpretation is to read this review as supporting the conclusion that cannabis is effective for symptom management in HIV and cancer. The review documents that some patients perceive benefit and that some studies report positive associations, but it simultaneously and explicitly highlights that the evidence base lacks the methodological rigor, specifically standardized dosing, validated outcome measures, and longitudinal designs, to support effectiveness claims. Reporting that associations exist in cross-sectional data is not the same as demonstrating that cannabis reliably improves symptoms, and the absence of formal quality appraisal means that even the reported associations may reflect substantial bias.

Bottom Line

This scoping review provides a useful and honest map of a literature that is broader than many clinicians may realize but far weaker than patient demand would require. It does not establish that cannabis is effective or safe for symptom management in HIV or cancer. It does establish that the research community has not yet produced the longitudinal, dose-controlled, validated-outcome studies needed to answer those questions, and that the comorbid population remains entirely unstudied. For now, the clinical imperative is to bring cannabis use into the documented conversation, not to recommend it on the basis of this evidence.

References

1. Kates FR, Gormley M, Engel R, et al. Cannabis use for symptom management among people living with HIV and/or cancer: a scoping review of quantitative observational studies. Journal of the Association of Nurses in AIDS Care. 2025. Funded by NIAAA and NIH.
2. National Academies of Sciences, Engineering, and Medicine. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: The National Academies Press; 2017. DOI: 10.17226/24625.
3. Tricco AC, Lillie E, Zarin W, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): checklist and explanation. Annals of Internal Medicine. 2018;169(7):467-473. DOI: 10.7326/M18-0850.