Cannabis for HIV and Cancer Symptom Management: A Scoping Review Finds Promising Signals but Major Evidence Gaps

A 2025 scoping review of 51 observational studies maps what is known about cannabis use for symptom management in HIV and cancer populations, revealing that cross-sectional designs dominate the literature, no studies address comorbid HIV and cancer, and reliable data on dosing, safety, and effectiveness remain insufficient to guide clinical practice.

Why This Matters

People living with HIV are surviving longer and developing non-AIDS-defining cancers at increasing rates, creating a comorbid population with layered symptom burdens including pain, fatigue, anxiety, and sleep disturbance. Cannabis use among these patients is rising, often without clinician guidance, and the 2023 recognition of cannabis nursing as a specialty by the American Nurses Association has heightened demand for evidence-based practice recommendations. This review arrives at a moment when clinical interest in cannabinoid therapeutics is outpacing the quality of the science available to inform it.

Clinical Summary

Cannabis is widely used by people living with HIV and by cancer patients to manage symptoms such as pain, nausea, anxiety, depression, and sleep disturbance. This scoping review, published in 2025 and funded by the NIH’s National Institute on Alcohol Abuse and Alcoholism, followed the PRISMA-ScR framework to systematically search PubMed, PsycInfo, CINAHL, and Embase for quantitative observational studies published between 2017 and 2022. The authors screened 1,738 abstracts and retained 51 studies, the majority of which were cross-sectional in design. The mechanistic rationale for cannabis in symptom management rests on endocannabinoid system modulation of pain signaling, appetite regulation, sleep architecture, and mood, though the review itself does not investigate mechanisms.

Among the included studies, some reported that patients perceived cannabis as effective for HIV-related symptom relief, and a subset found positive associations between cannabis use and antiretroviral therapy adherence or undetectable viral load. In cancer populations, more studies were available, but outcome measurement remained inconsistent and often inadequate. Critically, no studies examined people living with both HIV and cancer simultaneously, despite the clinical relevance of this growing population. The authors note that metrics on perceived effectiveness, safety, dosing, and mode of delivery were limited across the literature. They conclude that rigorous longitudinal research with standardized outcome measures is needed before clinical recommendations can responsibly be made.

Dr. Caplan’s Take

This review does exactly what a good scoping review should do: it tells us what the literature contains and, more importantly, what it does not. The finding that 37 of 51 studies are cross-sectional is sobering. When a patient with HIV or cancer tells me they are using cannabis for symptom relief and asks whether it is working, I have to be honest that the evidence base cannot yet answer that question with any confidence. The gap regarding comorbid HIV and cancer is particularly striking given how common this overlap has become in clinical practice.

In my own work, I take a harm-reduction and transparency approach. I ask about cannabis use routinely, document it, and discuss what we do and do not know. I counsel patients on potential drug interactions, particularly with antiretrovirals and chemotherapy agents, and I encourage reporting of both perceived benefits and adverse effects. I do not recommend cannabis initiation on the basis of this evidence, but I also do not dismiss patients who report subjective improvement. The priority is keeping the conversation clinical rather than ideological.

Clinical Perspective

This review sits at the earliest stage of the research arc for cannabis in these populations. It confirms that observational data exist and that patients are using cannabis, but it challenges any assumption that the evidence is mature enough to support structured clinical protocols. The overwhelming reliance on cross-sectional designs means we cannot determine whether cannabis use precedes, follows, or merely coincides with symptom changes. The absence of standardized outcome measures across studies further limits the ability to compare findings or aggregate evidence. For clinicians, this means that patient-facing conversations about cannabis should acknowledge its widespread use while clearly communicating that therapeutic efficacy has not been established by the current literature.

From a pharmacological standpoint, clinicians managing patients on antiretroviral therapy or cancer chemotherapy should be aware that cannabinoids are metabolized through cytochrome P450 pathways, particularly CYP3A4 and CYP2C9, raising the potential for interactions with protease inhibitors, non-nucleoside reverse transcriptase inhibitors, and certain chemotherapeutic agents. Safety data in these populations remain sparse. The single most actionable step clinicians can take now is to systematically ask about cannabis use during intake and medication reconciliation, documenting product type, dose, and frequency to begin generating the practice-level data that formal studies have not yet provided.

Study at a Glance

Study Type

Scoping review (PRISMA-ScR framework)

Population

Adults aged 18 and older with HIV and/or cancer

Intervention

Cannabis use for symptom management (all formulations and routes)

Comparator

Not applicable (observational mapping review)

Primary Outcomes

Scope, nature, and gaps in observational literature on cannabis use in HIV and cancer populations

Sample Size

51 studies retained from 1,738 screened abstracts

Databases Searched

PubMed (552), Embase (976), PsycInfo (204), CINAHL (164)

Search Timeframe

2017 to 2022

Geographic Distribution

39 US, 7 Canada, 3 Israel, 1 Thailand, 1 Denmark

Funding Source

NIH / National Institute on Alcohol Abuse and Alcoholism

What Kind of Evidence Is This

This is a scoping review conducted under the PRISMA-ScR checklist, positioning it as a literature-mapping exercise rather than an efficacy synthesis. Scoping reviews sit below systematic reviews and meta-analyses in the evidence hierarchy because they do not formally assess risk of bias in included studies or pool effect estimates. The most important inference constraint is that this review can characterize what the literature contains and where gaps exist, but it cannot establish whether cannabis is therapeutically effective or safe for any specific indication in these populations.

How This Fits With the Broader Literature

This review extends earlier narrative accounts of cannabis use in HIV and oncology settings by providing a structured, reproducible map of the observational evidence base. Its finding that cross-sectional designs dominate is consistent with broader critiques of the cannabis therapeutics literature, including those raised by the 2017 National Academies of Sciences report, which similarly noted the absence of well-designed longitudinal and experimental studies for most cannabis-related health claims. The identification of a complete gap in comorbid HIV-cancer research is a novel contribution.

The review also aligns with recent work highlighting that patients frequently obtain cannabis information from non-clinical sources, a finding reported in cancer populations by Pergam and colleagues (2017) and in HIV populations by Woolridge and colleagues. This consistency across reviews suggests that the information gap between patients and providers is structural, not incidental, and that addressing it requires deliberate clinical systems change.

Common Misreadings

The most likely overinterpretation of this review is treating the reported associations between cannabis use and symptom improvement or viral load suppression as evidence that cannabis produces these outcomes. Cross-sectional designs cannot establish temporal sequence, let alone causation. Patients who use cannabis may differ systematically from those who do not in ways that confound the observed associations, including in health literacy, access to care, or baseline symptom severity. Similarly, the review’s identification of perceived effectiveness should not be equated with measured effectiveness; patient perception, while clinically meaningful, is subject to expectancy effects and recall bias that these study designs cannot control.

Bottom Line

This well-conducted scoping review confirms that cannabis use among people with HIV and cancer is prevalent and that patients perceive some benefit, but it also demonstrates that the observational evidence base is methodologically weak, inconsistently measured, and entirely absent for the growing comorbid HIV-cancer population. The review does not establish therapeutic efficacy. It establishes the need for longitudinal, controlled research with standardized outcomes before clinical practice guidelines can be responsibly developed.

References

1. Breiddal S, Grov C, Rodriguez-Diaz CE, et al. Cannabis use for symptom management among people with HIV and cancer: a scoping review. Journal of Cannabis Research. 2025. Funded by NIH/NIAAA.
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. Pergam SA, Woodfield MC, Lee CM, et al. Cannabis use among patients at a comprehensive cancer center in a state with legalized medicinal and recreational use. Cancer. 2017;123(22):4488-4497. DOI: 10.1002/cncr.30879.
4. 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.