Epstein-Barr virus (EBV) is a recognized carcinogen implicated in several lymphoma subtypes. Although multiple reports document EBV in lymphomas, a comprehensive systematic evaluation quantifying the attributable fraction of EBV across lymphoma subtypes was lacking. The reviewed meta-analysis synthesizes published studies from 1990 to 2024 to estimate pooled EBV prevalence by histologic subtype, stratified by HIV status and geographical region, using a standardized detection method.
The analysis included 307 eligible studies comprising more than 21,140 lymphoma cases identified over the period 1990–2024. EBV presence in tumor tissue was defined by detection of EBV-encoded RNA using in situ hybridisation (EBER ISH). For each lymphoma subtype, the authors calculated pooled prevalence estimates with corresponding 95% confidence intervals (CIs). Analyses were stratified by HIV status (HIV-negative versus persons living with HIV, PLHIV) and by geographical region. The abstract reports numbers of studies and cases, the time frame, the EBV detection method, and the pooled prevalence results; additional methodological details (for example, study-level quality assessment, exact inclusion/exclusion criteria, or statistical heterogeneity metrics) are not provided in the abstract available here.
Among tumors diagnosed in HIV-negative individuals, the pooled prevalence of EBV (EBER-positive) by subtype was as follows:
These pooled prevalences represent the estimated fraction of tumors across included studies in which tumor cells were EBER-positive, and thus provide an estimate of EBV-attributable lymphoma for each subtype in HIV-negative populations.
The analysis found markedly higher EBV prevalence in several lymphoma subtypes occurring in PLHIV compared with HIV-negative tumors. Reported pooled prevalences among PLHIV included:
These differences underscore the increased role of EBV in lymphoma pathogenesis in the context of HIV infection.
Overall heterogeneity by geographical region was limited for most lymphoma subtypes in the pooled analysis. The primary regional difference reported in the abstract concerned Burkitt lymphoma, for which EBV positivity demonstrated clear heterogeneity: BL in East Africa showed near-universal EBV positivity. The abstract does not provide full regional breakdowns for every subtype; those detailed regional estimates and heterogeneity statistics are not included in the abstract available here.
This systematic review and meta-analysis provides comprehensive, pooled evidence that EBV substantially contributes to several lymphoma subtypes, with particularly high attributable fractions in ENKTL, Hodgkin lymphoma, and subsets of BL and PBL. The findings also highlight an amplified role for EBV in lymphomas arising among PLHIV.
The authors note that these pooled prevalence estimates can help quantify the global burden of EBV-related lymphomas and inform public health and clinical strategies. Specifically, the data may be useful when evaluating the potential impact of EBV-targeted interventions such as vaccines, supporting earlier diagnosis pathways, or development and application of targeted therapies for EBV-positive tumors.
The abstract presents core results and scope (number of included studies and cases, time frame, EBV detection method, pooled prevalences, and key subgroup findings). However, the abstract does not report several methodological details that would be relevant for critical appraisal, including the systematic review protocol, study-level risk of bias or quality assessments, exact inclusion and exclusion criteria, full regional prevalence tables, heterogeneity metrics for all subgroup analyses, or sensitivity analyses. Those details may be available in the full text but were not reported in the abstract provided here.
Using EBER in situ hybridisation data from 307 studies and over 21,140 lymphoma cases (1990–2024), this meta-analysis quantifies the EBV-attributable fraction across lymphoma subtypes. EBV prevalence varies markedly by subtype and by HIV status, with the highest proportions observed in ENKTL, Hodgkin lymphoma, and in lymphomas arising in PLHIV. Regional heterogeneity was most notable for Burkitt lymphoma, particularly in East Africa. These pooled estimates can inform burden-of-disease calculations and guide public health and clinical strategies focused on prevention, diagnosis, and treatment of EBV-related lymphomas.