Major Gaps Found in Research on Cannabis for Symptom Relief in HIV and Cancer Patients

A scoping review of 51 studies finds mostly cross-sectional, low-causal-certainty evidence on cannabis for symptom management in HIV and cancer, with no studies at all addressing patients living with both conditions simultaneously.

Why This Matters

Cannabis use for symptom management among people living with HIV and cancer is widespread and growing, yet clinicians are being asked to counsel patients with almost no rigorous evidence to guide them. The American Nurses Association formally recognized cannabis nursing as a specialty in 2023, raising the stakes for evidence-informed practice. This review arrives at a moment when the gap between patient demand for guidance and the quality of available research is especially consequential, particularly as non-AIDS-defining cancers become a leading cause of morbidity in people with HIV.

Clinical Summary

Adults living with HIV and cancer frequently use cannabis to manage symptoms such as pain, nausea, appetite loss, insomnia, and anxiety. The biological plausibility for cannabinoid-mediated symptom relief rests on the endocannabinoid system’s established roles in pain modulation, appetite regulation, and immune signaling. Zolot and colleagues (2025), publishing in the Journal of the Association of Nurses in AIDS Care, conducted a PRISMA-ScR-compliant scoping review of four major databases covering 2017 through 2022 to map the existing observational evidence on cannabis use for symptom management in these populations. The review retained 51 studies from an initial pool of 1,738 screened articles and characterized the field’s scope, dominant designs, and critical knowledge gaps.

Of the 51 retained studies, 37 were cross-sectional, 11 were cohort studies, and 3 were case-control designs. Cannabis use was self-reported as effective for managing HIV-related symptoms in several studies, and some cross-sectional analyses found positive associations between cannabis use, antiretroviral therapy adherence, and undetectable viral load. Cannabis was also significantly associated with total sleep time in people with HIV, though not with sleep efficiency or sleep fragmentation. Critically, no studies addressed the comorbid HIV-cancer population. Outcome measures were heterogeneous and frequently unstandardized, dosing and mode of delivery were rarely reported, and the geographic concentration was overwhelming, with 39 of 51 studies conducted in the United States. The authors conclude that longitudinal designs, standardized symptom instruments, and research on the comorbid population are essential before clinical recommendations can responsibly be made.

Dr. Caplan’s Take

What strikes me most about this review is not what it found but what it could not find. We have patients in our clinic every week, people living with HIV who are managing cancer treatment side effects, asking whether cannabis might help with nausea, pain, or sleep. The honest answer, based on this mapping of the literature, is that we are working from snapshot surveys and self-reports. The mechanistic case is plausible, but the evidentiary case is almost entirely cross-sectional, meaning we cannot distinguish genuine symptom relief from expectation effects, recall bias, or unmeasured confounding.

In practice, when patients are already using cannabis and reporting subjective benefit, I focus on harm reduction: understanding what they are using, how they are dosing, and whether there are interactions with their current medications, particularly antiretrovirals or chemotherapy agents. I do not recommend initiating cannabis for symptom management based on this evidence base, but I also do not dismiss patients who find it helpful. What I emphasize is monitoring, documentation, and an open conversation rather than deferring to the internet or a friend’s recommendation.

Clinical Perspective

This scoping review confirms what many clinicians suspect: the research infrastructure for cannabis in serious chronic illness lags far behind patient uptake. The dominance of cross-sectional designs means the field has not yet progressed to the stage where causation, dose-response relationships, or sustained outcomes can be assessed. For the comorbid HIV-cancer population, the absence of any research is a particularly acute gap given the epidemiological reality that non-AIDS-defining cancers now represent a leading cause of morbidity and mortality in people with HIV on effective antiretroviral therapy. Clinicians should not interpret the associational findings reported here as evidence of efficacy.

From a pharmacological standpoint, cannabis poses real considerations for this population. THC and CBD are metabolized by cytochrome P450 enzymes, including CYP3A4 and CYP2C9, creating the potential for interactions with protease inhibitors, non-nucleoside reverse transcriptase inhibitors, and multiple chemotherapy agents. Immunomodulatory effects of cannabinoids remain poorly characterized in immunocompromised patients. The most actionable step clinicians can take now is to routinely ask about cannabis use during medication reconciliation and document mode of delivery, frequency, and perceived effects, building the observational foundation this field clearly needs.

Study at a Glance

Study Type

Scoping review (PRISMA-ScR)

Population

Adults with HIV and/or cancer using cannabis for symptom management

Intervention

Cannabis use (all forms; not standardized across included studies)

Comparator

Not applicable (mapping review, not comparative synthesis)

Primary Outcomes

Scope and nature of observational evidence; identification of knowledge gaps

Sample Size

51 studies retained from 1,738 screened

Dominant Design in Corpus

Cross-sectional (n=37 of 51)

Geographic Focus

Predominantly United States (n=39)

Journal

Journal of the Association of Nurses in AIDS Care

Year

2025

Funding Source

NIAAA, NIH

What Kind of Evidence Is This

This is a scoping review conducted according to the PRISMA-ScR checklist, designed to map the breadth, nature, and gaps in an emerging evidence base rather than to estimate treatment effects. Scoping reviews sit below systematic reviews and meta-analyses in the evidence hierarchy because they do not formally appraise the quality of included studies. The most important inference constraint is that no conclusions about whether cannabis is effective or harmful for symptom management can be drawn from this work; it tells us what research exists and where it falls short.

How This Fits With the Broader Literature

This review builds on and updates earlier mapping work by characterizing the 2017 through 2022 literature specifically. Its finding that cross-sectional designs dominate is consistent with prior assessments of the cannabinoid therapeutics field more broadly, including the 2017 National Academies report, which similarly noted a paucity of rigorous clinical trial data for most cannabis-related health claims. The identification of a complete absence of studies on comorbid HIV-cancer adds a new and consequential dimension. Prior reviews of cannabis in oncology, such as Whiting and colleagues’ 2015 systematic review, focused primarily on chemotherapy-induced nausea and vomiting and also highlighted significant limitations in study quality, suggesting that the evidence deficit identified here is part of a broader and persistent pattern across cannabinoid research.

Common Misreadings

The most likely overinterpretation is to read the review’s finding that patients “perceived cannabis as effective” for symptom management as evidence that cannabis works for these symptoms. Self-reported perceived effectiveness in cross-sectional surveys cannot establish therapeutic benefit. Expectation effects, recall bias, selection bias (patients who did not find cannabis helpful may have stopped using it and therefore would not appear in prevalence surveys), and unmeasured confounders all represent plausible alternative explanations. Similarly, the positive associations between cannabis use and antiretroviral adherence should not be interpreted as causal; the direction of this relationship and the role of confounding variables remain entirely unresolved.

Bottom Line

This scoping review provides a useful and sobering map of the observational evidence on cannabis for symptom management in HIV and cancer. The field is dominated by cross-sectional, US-based surveys with unstandardized outcomes and absent dosing data. No research exists for the comorbid HIV-cancer population. The review does not establish that cannabis is effective or safe for these indications. It establishes that we do not yet have the evidence to say either way, and that building that evidence requires fundamentally different study designs.

References

1. Zolot J, et al. Cannabis use for symptom management in adults with HIV and/or cancer: a scoping review. Journal of the Association of Nurses in AIDS Care. 2025. Funded by NIAAA/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.
3. Whiting PF, Wolff RF, Deshpande S, et al. Cannabinoids for medical use: a systematic review and meta-analysis. JAMA. 2015;313(24):2456-2473. doi:10.1001/jama.2015.6358
4. American Nurses Association. Cannabis nursing: scope and standards of practice. Silver Spring, MD: ANA; 2023.