Erminia Fardone, PhD
University of Miami
Co-Authors: Don Lochana Ekanayake1, Kathryn E McCollister1
1University of Miami
Background: Despite effective antiretroviral therapy (ART), individuals living with HIV (PLWH) continue to experience persistent neuroinflammation and immune activation due to viral reservoirs, including those in the brain. The blood-brain barrier (BBB) restricts drug penetration and immune surveillance, contributing to neurological complications. Many PLWH utilize cannabis to alleviate symptoms such as pain, appetite loss, and mood disturbances. Emerging evidence indicates that cannabis may possess anti-inflammatory and neuroprotective properties through the Endocannabinoid System (ECS). However, its direct effects on brain health—via neuroimaging—and indirect effects through gut-immune interactions remain poorly understood. Additionally, little is known about the cost-effectiveness of cannabis compared to conventional treatments for improving both health outcomes and the quality of life.
Objective: This review synthesizes the literature on cannabis use in PLWH, focusing on neuroimaging outcomes and gut-immune biomarkers. It aims to identify research gaps and assess the therapeutic potential of cannabis for managing HIV-related neurological and systemic complications, as well as its influence on quality of life.
Methods: Following PRISMA guidelines, a systematic search of PubMed, Embase, CINAHL, Cochrane, and Web of Science was conducted through December 2024. Search terms included “cannabis,” “neuroimaging,” “gut-immune dysfunction,” and “HIV.” Zotero® managed references, and Covidence® facilitated study screening. Eligible studies examined cannabis use in PLWH, neuroimaging outcomes (e.g., Magnetic Resonance Spectroscopy, functional MRI), gut-immune biomarkers (e.g., microbiota composition, C-reactive protein), and costs when available. Data were extracted and organized using Microsoft Excel®.
Results: Out of 995 articles screened, two primary outcome categories were identified: (1) neuroimaging research focusing on cannabis’ direct effects on brain structure and function and (2) gut-immune biomarker studies evaluating the impact of cannabis on inflammation and microbiota composition. Additionally, some studies explored the broader effects on quality of life and symptom management, although data regarding costs were limited.
Conclusions: This review presents initial evidence indicating that cannabis could alleviate neuroinflammation and influence gut-immune dysfunction in individuals living with HIV. Nonetheless, comprehensive longitudinal studies that include neuroimaging, biomarker analyses, and economic assessments are crucial to establish the therapeutic benefits and cost-effectiveness of cannabis in tackling HIV-related comorbidities.