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EBV prevalence varies widely across lymphoma subtypes, highest in ENKTL at 92.4%EBV Presence Linked to Lymphoma Cases in People with HIV
International journal of cancerPublished August 15, 2026Study authors: Hirabayashi Mayo, Georges Damien, Combes Jean-Damien, Clifford Gary MPubMed ↗DOI ↗Editorial oversight: Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease
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Key Takeaway
Consider EBV prevalence when evaluating lymphoma subtypes, especially ENKTL and HIV-associated cases.
This meta-analysis pooled data from 307 studies encompassing more than 21,140 lymphoma cases to estimate the prevalence of Epstein-Barr virus (EBV) across various lymphoma subtypes, with stratification by HIV status and geographical region. The primary outcome was the pooled prevalence of EBV, measured by EBV-encoded RNA in situ hybridisation.
Among HIV-negative lymphomas, EBV prevalence was highest in extranodal NK/T-cell lymphoma (ENKTL) at 92.4% (95% CI 83.3%-96.7%), followed by Hodgkin lymphoma at 53.0% (95% CI 46.9%-58.9%) and plasmablastic lymphoma at 52.5% (95% CI 29.6%-74.4%). Burkitt lymphoma showed 45.8% (95% CI 35.2%-56.8%), while diffuse large B-cell lymphoma (DLBCL) had 10.8% (95% CI 8.6%-13.5%) and follicular lymphoma had 5.1% (95% CI 2.7%-9.4%).
In HIV-positive lymphomas, EBV prevalence was notably higher in DLBCL (43.6%, 95% CI 31.5%-56.5%) and plasmablastic lymphoma (79.4%, 95% CI 65.6%-88.6%) compared to HIV-negative cases. Burkitt lymphoma in HIV-positive individuals showed 43.3% (95% CI 27.9%-60.2%).
The authors note that these data can contribute to estimating the burden of EBV-related disease and inform public health and clinical strategies, such as vaccines, early diagnosis, and targeted therapies. The text also mentions evidence for a causal role of EBV in lymphoma subtypes. However, limitations were not reported, and the findings are not stated as a clinical recommendation for specific treatments.
How this fits prior evidence
This meta-analysis extends prior coverage by providing quantitative prevalence estimates for EBV across lymphoma subtypes, complementing earlier findings on circRNAs as immune checkpoint hubs and EBUS techniques for diagnosis. It confirms the well-recognized association between EBV and ENKTL, and highlights the higher EBV prevalence in HIV-positive DLBCL and plasmablastic lymphoma, reinforcing the need for EBV-targeted strategies in these populations. The data address a gap by offering pooled global estimates, though regional heterogeneity was noted.
Researchers analyzed data from 307 studies involving over 21,140 cases of lymphoma. The study looked at how often the Epstein-Barr virus (EBV) was present in different types of lymphoma, comparing patients who had HIV to those who did not.
The findings showed that EBV was more common in some lymphoma types for people living with HIV. For example, EBV was found in 43.6% of DLBCL cases in HIV-positive patients, compared to 10.8% in HIV-negative patients. Similarly, it was found in 79.4% of plasmablastic lymphoma cases in those with HIV, which was higher than the 52.5% seen in those without HIV.
Because this is a large review of existing data rather than a new clinical trial, these results are used to help experts understand how EBV affects different groups. These findings may help doctors better understand public health risks and develop better ways to diagnose or treat lymphoma in people living with HIV.
What this means for you:
EBV is more common in several types of lymphoma among people living with HIV than in those without the virus.
Common questions
Is the Epstein-Barr virus more common in patients with HIV?
The study found that EBV was more common in some lymphoma types for people living with HIV. For example, EBV was present in 43.6% of DLBCL cases in HIV-positive patients compared to only 10.8% in those who were HIV-negative.
Which specific types of lymphoma showed higher EBV rates in HIV patients?
EBV was found in 79.4% of plasmablastic lymphoma cases in people living with HIV, which is higher than the 52.5% rate seen in those without HIV. The study also noted high EBV presence in other types like Burkitt lymphoma and NK/T-cell lymphoma.
How much data was used to reach these conclusions?
The findings are based on a large meta-analysis of 307 different studies. These studies included more than 21,140 cases of lymphoma from various types and geographic regions across the globe.
There is evidence for a causal role of Epstein-Barr virus (EBV), a known carcinogen, in an increasing number of lymphoma subtypes, but a systematic evaluation of EBV attributable fraction is lacking. We conducted a systematic review and meta-analysis of EBV prevalence in lymphoma subtypes from 1990 to 2024, stratified by HIV status and geographical region. For each subtype, we calculated pooled prevalence and corresponding 95% confidence intervals (CIs) of EBV, measured by EBV-encoded RNA in situ hybridisation. 307 eligible studies, including > 21,140 lymphoma cases, were included. In HIV-negative persons, EBV pooled prevalence was 10.8% (95% CI 8.6%-13.5%) in Diffuse large B-cell lymphoma (DLBCL), 45.8% (35.2%-56.8%) in Burkitt lymphoma (BL), 53.0% (46.9%-58.9%) in Hodgkin lymphoma, 52.5% (29.6%-74.4%) in plasmablastic lymphoma, 92.4% (83.3%-96.7%) in extranodal NK/T-cell lymphoma (ENKTL), and 5.1% (2.7%-9.4%) in follicular lymphoma. EBV prevalence was higher among tumors diagnosed among persons living with HIV (PLHIV), for DLBCL (43.6% (95% CI 31.5%-56.5%)), BL (43.3% (27.9%-60.2%)), and PBL (79.4% (65.6%-88.6%)), compared to HIV-negative tumors. BL was the only subtype with evidence of heterogeneity in EBV positivity by region, with near-universal EBV positivity in East African BL. This provides the first systematic and comprehensive evidence on EBV's substantial contribution to lymphoma, highlighting its particular importance in lymphomas arising in PLHIV. These data can contribute to estimating the complete burden of EBV-related disease and inform public health and clinical strategies, including vaccines, early diagnosis, or targeted therapies.
