CBD and THC Capsules Alter Endocannabinoid Markers in People Living with HIV | Research

The takeaway

A 12-week pilot trial in people with HIV found that oral cannabinoids reduced specific endocannabinoid-related lipid mediators but did not significantly change gut bacterial composition.

HIV researchers, clinicians exploring cannabinoid therapeutics, and scientists studying the endocannabinoid system and gut microbiome.

What the researchers found

Cannabinoid capsule administration significantly decreased plasma levels of two monoacylglycerols (2-EPG and 2-OG), part of the expanded endocannabinoid system, but did not alter fecal bacterial taxa after 12 weeks of treatment in people with HIV on antiretroviral therapy.

Why it matters

People with HIV experience chronic inflammation driving comorbidities, and this study provides early mechanistic evidence that cannabinoids may modulate the endocannabinoid system in this population.

The numbers in context

n=10 (5 per arm); 12-week treatment; significant decrease in 2-EPG and 2-OG; different baseline bacterial taxa between arms; Coprobacillus and Lachnospiraceae UCG001 lower in THC/CBD vs CBD-only arm

How the study worked

Prospective pilot clinical trial randomizing 10 people with HIV on ART to CBD+THC (n=5) or CBD-only (n=5) capsules for 12 weeks, with plasma eCBome mediators measured by LC-MS-MS and fecal microbiota assessed by 16S rDNA sequencing.

What this study cannot tell us

Very small sample size (n=10); no placebo control arm; different baseline microbiota between groups; short duration; dose titration means variable cannabinoid exposure; pilot study not powered for definitive conclusions.

How to read the evidence

Pilot clinical trial with objective biomarker outcomes, but very small sample size (n=10) and lack of placebo control limit interpretability.

When this study was published

Published 2026; registered as CTN PT028.

The bigger picture

Understanding how cannabinoids interact with the endocannabinoid system and gut microbiome in immunocompromised populations could open new avenues for managing HIV-related chronic inflammation.

Questions still open

Do the reductions in 2-EPG and 2-OG translate to clinical anti-inflammatory benefits? Would longer treatment or larger doses affect gut microbiota? How do these changes compare in HIV-negative individuals?

Common questions

Can cannabis help with HIV-related inflammation?

This pilot study found that CBD and THC capsules altered endocannabinoid system markers linked to inflammation in people with HIV, but the sample was too small (n=10) to draw clinical conclusions.

Does cannabis change the gut microbiome in people with HIV?

This 12-week pilot found no significant changes in gut bacterial composition from cannabinoid treatment, though some differences were noted between the CBD+THC and CBD-only groups.

Read the original research

Impact of Oral Cannabinoids on the Endocannabinoidome and Gut Microbiome in People with HIV on Antiretroviral Therapy (CTN PT028 Pilot Clinical Trial).

Cannabis and cannabinoid research, 25785125251366052

View on PubMed ↗Publisher’s paper ↗

Citation

Giorgini, Giada; Silvestri, Cristoforo; Mboumba Bouassa, Ralph-Sydney; Muller, Chante; Frias Boligan, Kayluz; Kalkan, Hilal; Routy, Jean-Pierre; Flamand, Nicolas; Di Marzo, Vincenzo; Jenabian, Mohammad-Ali; Costiniuk, Cecilia T. (2026). Impact of Oral Cannabinoids on the Endocannabinoidome and Gut Microbiome in People with HIV on Antiretroviral Therapy (CTN PT028 Pilot Clinical Trial).. Cannabis and cannabinoid research, 25785125251366052. https://doi.org/10.1177/25785125251366052