Alzheimer’s disease (AD) and related dementias lead to massive costs and human suffering in the United States and worldwide and the number of people affected by these diseases is expected to increase as the global population age increases. Although aging is the greatest known risk factor for the development of neurodegenerative diseases like AD, concurrent HIV infection and ensuing oxidative stress and chronic inflammation may potentially facilitate the development of AD. Chronic neuroinflammation characterized by persistent activation brain microglia is considered a central mechanism in AD and may potentiate its pathogenesis. Our preliminary studies identified significant upregulation of oxidative stress and proinflammatory interferon stimulated and chemokine genes in basal ganglia of chronically SIV-infected macaques. More importantly, chronic cannabinoid treatment to ART naïve SIV-infected rhesus macaques suppressed proinflammatory gene expression in BG, and more importantly, significantly increased plasma concentrations of indole-3-propionate, a gut microbe derived indole metabolite with potent ability to suppress oxidative stress, neuroinflammation and inhibit amyloid-beta fibril formation given as a supplement (OXIGON ®) to AD patients suggesting their immense therapeutic potential for attenuating neuroinflammation and neurocognitive decline in AD patients. In rodent models of AD, cannabinoids reduced neuroinflammation and stimulated neurogenesis in the hippocampus. To obtain a deeper understanding of the mechanisms associated with anti-inflammatory and neurogenic potential of cannabinoids, we will utilize spatial transcriptomics to analyze gene expression changes in cells in their morphological context to unravel the pathological changes caused by amyloid plaques on adjacent cells like astrocytes, neurons, microglia, etc. in the brain Further, we will determine the effect of combination anti-retroviral treatment (cART) in conjunction with chronic cannabinoid treatments longitudinally on neurocognitive function, levels of proinflammatory cytokine and other markers in blood and cerebrospinal fluid and microglial activation using PET/CT imaging. The proposed research is highly innovative and applies state of the art immunological, imaging and molecular approaches to fill a significant gap in our understanding of the proinflammatory mechanisms associated with AD and HAND and its modulation by safe disease modifying interventions like low dose cannabinoids.