{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T00:24:22Z","timestamp":1791419062482,"version":"4.3.3"},"reference-count":47,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2023,8,15]],"date-time":"2023-08-15T00:00:00Z","timestamp":1692057600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"The Ohio State University","award":["3R01AI141531"],"award-info":[{"award-number":["3R01AI141531"]}]},{"name":"Addis Ababa University","award":["3R01AI141531"],"award-info":[{"award-number":["3R01AI141531"]}]},{"name":"NIH R01","award":["3R01AI141531"],"award-info":[{"award-number":["3R01AI141531"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Viruses"],"abstract":"<jats:p>Epstein\u2013Barr virus (EBV) is a well-known risk factor for the development of nasopharyngeal carcinoma, Hodgkin\u2019s lymphoma (HL), and Non-Hodgkin\u2019s lymphoma (NHL). People with HIV infection (PWH) are at increased risk for EBV-associated malignancies such as HL and NHL. Nevertheless, there are limited data on the burden of EBV among this population group in Ethiopia. Hence, this study aimed to determine the burden of EBV infection among adult HIV-positive individuals in Ethiopia and assess the determinants of EBV DNA positivity. We conducted a cross-sectional study at the Tikur Anbessa Specialised Hospital from March 2020 to March 2021. Two hundred and sixty individuals were enrolled in this study, including 179 HIV-positive and 81 HIV-negative individuals. A structured questionnaire was used to capture demographic and individual attributes. In addition, the clinical data of patients were also retrieved from clinical records. EBV viral capsid antigen (VCA) IgG antibody was measured by multiplex flow immunoassay, and EBV DNA levels were tested by quantitative real-time polymerase chain reaction (q-PCR) assays targeting the EBNA-1 open reading frame (ORF). Descriptive statistics were conducted to assess each study variable. A multivariable logistic regression model was applied to evaluate the determinants of EBV infection. Statistical significance was determined at a p-value &lt; 0.05. Two hundred and fifty-three (97.7%) study participants were seropositive for the EBV VCA IgG antibody. Disaggregated by HIV status, 99.4% of HIV-positive and 93.8% of HIV-negative participants were EBV seropositive. In this study, 49.7% of HIV-positive and 24.7% of HIV-negative individuals were EBV DNA positive. PWH had a higher risk of EBV DNA positivity at 3.05 times (AOR: 3.05, 95% CI: 1.40\u20136.67). Moreover, among PWH, those with an HIV viral load greater than 1000 RNA copies\/mL (AOR = 5.81, 95% CI = 1.40, 24.13) had a higher likelihood of EBV DNA positivity. The prevalence of EBV among PWH was significantly higher than among HIV-negative individuals. Higher HIV viral loads in PWH were associated with an increased risk of EBV DNA positivity. Since the increases in the viral load of EBV DNA among PWH could be related to the risk of developing EBV-associated cancers, it is necessary for more research on the role of EBV in EBV-associated cancer in this population group to be carried out.<\/jats:p>","DOI":"10.3390\/v15081743","type":"journal-article","created":{"date-parts":[[2023,8,15]],"date-time":"2023-08-15T11:06:16Z","timestamp":1692097576000},"page":"1743","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["The Burden of Epstein\u2013Barr Virus (EBV) and Its Determinants among Adult HIV-Positive Individuals in Ethiopia"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5248-5036","authenticated-orcid":false,"given":"Kidist","family":"Zealiyas","sequence":"first","affiliation":[{"name":"Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa 1176, Ethiopia"},{"name":"Ethiopian Public Health Institute, Addis Ababa 1242, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3334-522X","authenticated-orcid":false,"given":"Seifegebriel","family":"Teshome","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Immunology and Parasitology, Addis Ababa University, Addis Ababa 9086, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nega","family":"Berhe","sequence":"additional","affiliation":[{"name":"Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa 1176, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4950-3966","authenticated-orcid":false,"given":"Wondwossen","family":"Amogne","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa 9086, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-1880-1674","authenticated-orcid":false,"given":"Aklilu Feleke","family":"Haile","sequence":"additional","affiliation":[{"name":"Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa 1176, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ebba","family":"Abate","sequence":"additional","affiliation":[{"name":"Global One Health Initiative, Addis Ababa 1000, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Getnet","family":"Yimer","sequence":"additional","affiliation":[{"name":"Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa 9086, Ethiopia"},{"name":"Center for Global Genomics and Health Equity, Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Weigel","sequence":"additional","affiliation":[{"name":"Comprehensive Cancer Center, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH 43210, USA"},{"name":"Division of Hematology, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH 43210, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2525-7123","authenticated-orcid":false,"given":"Elshafa Hassan","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Comprehensive Cancer Center, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH 43210, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamrat","family":"Abebe","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Immunology and Parasitology, Addis Ababa University, Addis Ababa 9086, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Baiocchi","sequence":"additional","affiliation":[{"name":"Comprehensive Cancer Center, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH 43210, USA"},{"name":"Division of Hematology, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH 43210, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,8,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"780887","DOI":"10.3389\/fmicb.2021.780887","article-title":"Insights Into the Coinfections of Human Immunodeficiency Virus-Hepatitis B Virus, Human Immunodeficiency Virus-Hepatitis C Virus, and Hepatitis B Virus-Hepatitis C Virus: Prevalence, Risk Factors, Pathogenesis, Diagnosis, and Treatment","volume":"12","author":"Shahriar","year":"2022","journal-title":"Front. Microbiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1007\/s11904-015-0276-6","article-title":"The role of viral co-infection in HIV-associated non-AIDS-related cancers","volume":"12","author":"Riedel","year":"2015","journal-title":"Curr. HIV\/AIDS Rep."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1111\/hiv.12034","article-title":"Incidence of AIDS-defining cancers and virus-related and non-virus-related non-AIDS-defining cancers among HIV-infected patients compared with the general population in a large health district of Northern Italy, 1999\u20132009","volume":"14","author":"Calabresi","year":"2013","journal-title":"HIV Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1016\/j.bbadis.2007.12.005","article-title":"Viruses associated with human cancer","volume":"1782","author":"Munger","year":"2008","journal-title":"Biochim. Biophys. Acta"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"713","DOI":"10.3389\/fonc.2019.00713","article-title":"The Global Landscape of EBV-Associated Tumors","volume":"9","author":"Rickinson","year":"2019","journal-title":"Front. Oncol."},{"key":"ref_6","unstructured":"Thorley-Lawson, D.A. (2015). Epstein Barr Virus Volume 1, Springer."},{"key":"ref_7","first-page":"e2009032","article-title":"EBV and HIV-related lymphoma","volume":"1","author":"Bibas","year":"2009","journal-title":"Mediterr. J. Hematol. Infect. Dis."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1244","DOI":"10.1086\/378808","article-title":"Epstein-Barr virus DNA loads in adult human immunodeficiency virus type 1-infected patients receiving highly active antiretroviral therapy","volume":"37","author":"Ling","year":"2003","journal-title":"Clin. Infect. Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1769","DOI":"10.3324\/haematol.2010.023689","article-title":"The interplay between Epstein-Barr virus and the immune system: A rationale for adoptive cell therapy of EBV-related disorders","volume":"95","author":"Merlo","year":"2010","journal-title":"Haematologica"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1723","DOI":"10.3389\/fonc.2020.01723","article-title":"Immunology of EBV-Related Lymphoproliferative Disease in HIV-Positive Individuals","volume":"10","author":"Shindiapina","year":"2020","journal-title":"Front. Oncol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1007\/s13337-020-00649-0","article-title":"High prevalence of plasma EBV DNA among the HIV positive individuals, with or without malignancies, attending the clinic at AIIMS, New Delhi","volume":"32","author":"Mandal","year":"2021","journal-title":"Virusdisease"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"34","DOI":"10.2174\/1874613601610010034","article-title":"HIV infection and AIDS in sub-Saharan Africa: Current status, challenges and opportunities","volume":"10","author":"Kharsany","year":"2016","journal-title":"Open AIDS J."},{"key":"ref_13","unstructured":"The Ethiopian Public Health Institute, Ministry of Health (2022). HIV Related Estimates and Projections in Ethiopia for the Year 2021\u20132022, The Ethiopian Public Health Institute."},{"key":"ref_14","unstructured":"Central Statistical Agency (2016). Ethiopia Demographic and Health Survey, Central Statistical Agency."},{"key":"ref_15","unstructured":"Ethiopian Public Health Institute (2020). Ethiopia Population-Based HIV Impact Assessment 2017\u20132018, Ethiopian Public Health Institute."},{"key":"ref_16","first-page":"1","article-title":"Estimates of cancer incidence in Ethiopia in 2015 using population-based registry data","volume":"4","author":"Memirie","year":"2018","journal-title":"J. Glob. Oncol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1056\/NEJM199803263381301","article-title":"Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection","volume":"338","author":"Palella","year":"1998","journal-title":"N. Engl. J. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1089","DOI":"10.1002\/cncr.25547","article-title":"Cumulative incidence of cancer among individuals with acquired immunodeficiency syndrome in the United States","volume":"117","author":"Simard","year":"2011","journal-title":"Cancer"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1111\/j.1365-2249.2007.03526.x","article-title":"Immune reconstitution in human immunodeficiency virus type 1-infected children with different virological responses to anti-retroviral therapy","volume":"150","author":"Anselmi","year":"2007","journal-title":"Clin. Exp. Immunol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"261","DOI":"10.4103\/0255-0857.136558","article-title":"Significance of Epstein-Barr virus (HHV-4) and CMV (HHV-5) infection among subtype-C human immunodeficiency virus-infected individuals","volume":"32","author":"Sachithanandham","year":"2014","journal-title":"Indian J. Med. Microbiol."},{"key":"ref_21","unstructured":"Ministry of Health (2018). National Guidelines for Comprehensive HIV Prevention, Care and Treatment, Ministry of Health."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Ahmed, E.H., Lustberg, M., Hale, C., Sloan, S., Mao, C., Zhang, X., Ozer, H.G., Schlotter, S., Smith, P.L., and Jeney, F. (2023). Follicular Helper and Regulatory T Cells Drive the Development of Spontaneous Epstein\u2013Barr Virus Lymphoproliferative Disorder. Cancers, 15.","DOI":"10.3390\/cancers15113046"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/j.canlet.2011.03.003","article-title":"Gammaherpesvirus and lymphoproliferative disorders in immunocompromised patients","volume":"305","author":"Cesarman","year":"2011","journal-title":"Cancer Lett."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1993","DOI":"10.1056\/NEJMcp1001116","article-title":"Infectious Mononucleosis","volume":"362","author":"Luzuriaga","year":"2010","journal-title":"N. Engl. J. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"aaa0698","DOI":"10.1126\/science.aaa0698","article-title":"Comprehensive serological profiling of human populations using a synthetic human virome","volume":"348","author":"Xu","year":"2015","journal-title":"Science"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e84967","DOI":"10.5812\/jkums.84967","article-title":"Seroprevalence of Epstein-Barr Virus in HIV-Infected Patients, A Case Control Study","volume":"23","author":"Keramat","year":"2019","journal-title":"J. Kermanshah Univ. Med. Sci."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1056\/NEJM199501053320103","article-title":"Association of Epstein\u2013Barr virus with leiomyosarcomas in young people with AIDS","volume":"332","author":"McClain","year":"1995","journal-title":"N. Engl. J. Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1869","DOI":"10.1089\/aid.1992.8.1869","article-title":"Expression of B-type Epstein-Barr virus in HIV-infected patients and cardiac transplant recipients","volume":"8","author":"Kyaw","year":"1992","journal-title":"AIDS Res. Hum. Retroviruses"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Schaftenaar, E., Verjans, G.M., Getu, S., McIntyre, J.A., Struthers, H.E., Osterhaus, A.D., and Peters, R.P. (2014). High seroprevalence of human herpesviruses in HIV-infected individuals attending primary healthcare facilities in rural South Africa. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0099243"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Adjei, A.A., Armah, H.B., Gbagbo, F., Boamah, I., Adu-Gyamfi, C., and Asare, I. (2008). Seroprevalence of HHV-8, CMV, and EBV among the general population in Ghana, West Africa. BMC Infect. Dis., 8.","DOI":"10.1186\/1471-2334-8-111"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"100641","DOI":"10.1016\/j.nmni.2019.100641","article-title":"Seroprevalence of Epstein\u2013Barr virus among children and adults in Tehran, Iran","volume":"34","author":"Sharifipour","year":"2020","journal-title":"New Microbes New Infect."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Smatti, M.K., Yassine, H.M., AbuOdeh, R., AlMarawani, A., Taleb, S.A., Althani, A.A., and Nasrallah, G.K. (2017). Prevalence and molecular profiling of Epstein Barr virus (EBV) among healthy blood donors from different nationalities in Qatar. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0189033"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1016\/j.jcv.2008.03.017","article-title":"The predictive value of cerebrospinal fluid Epstein-Barr viral load as a marker of primary central nervous system lymphoma in HIV-infected persons","volume":"42","author":"Corcoran","year":"2008","journal-title":"J. Clin. Virol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1093\/trstmh\/trx083","article-title":"High rates of cerebral toxoplasmosis in HIV patients presenting with meningitis in Accra, Ghana","volume":"111","author":"Opintan","year":"2017","journal-title":"Trans. R. Soc. Trop. Med. Hyg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"274","DOI":"10.4269\/ajtmh.14-0452","article-title":"Epidemiology of meningitis in an HIV-infected Ugandan cohort","volume":"92","author":"Rajasingham","year":"2015","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1093\/infdis\/jir707","article-title":"Epstein-barr virus coinfection in cerebrospinal fluid is associated with increased mortality in Malawian adults with bacterial meningitis","volume":"205","author":"Kelly","year":"2012","journal-title":"J. Infect. Dis."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"2330","DOI":"10.1017\/S0950268817001054","article-title":"Differential prevalence and correlates of whole blood Epstein\u2013Barr virus DNA between HIV-positive and HIV-negative men who have sex with men in Shanghai, China","volume":"145","author":"Pan","year":"2017","journal-title":"Epidemiol. Infect."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1034\/j.1601-0825.2001.70108.x","article-title":"Presence of Epstein\u2013Barr virus, cytomegalovirus and human papillomavirus in normal oral mucosa of HIV-infected and renal transplant patients","volume":"7","author":"Ammatuna","year":"2001","journal-title":"Oral Dis."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1590\/1806-9282.60.03.016","article-title":"Epstein-Barr virus in oral mucosa from human immunodeficiency virus positive patients","volume":"60","author":"Santos","year":"2014","journal-title":"Rev. Assoc. M\u00e9dica Bras."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1635","DOI":"10.1002\/jmv.20748","article-title":"Epidemiology of Epstein\u2013Barr virus, cytomegalovirus, and kaposi\u2019s sarcoma-associated herpesvirus infections in peripheral blood leukocytes revealed by a multiplex PCR assay","volume":"78","author":"Nishiwaki","year":"2006","journal-title":"J. Med. Virol."},{"key":"ref_41","first-page":"707","article-title":"Epstein-Barr virus in healthy individuals from Portugal","volume":"24","author":"Sousa","year":"2011","journal-title":"Acta M\u00e9dica Port."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Abusalah, M.A.H., Gan, S.H., Al-Hatamleh, M.A., Irekeola, A.A., Shueb, R.H., and Yean Yean, C. (2020). Recent advances in diagnostic approaches for epstein\u2013barr virus. Pathogens, 9.","DOI":"10.3390\/pathogens9030226"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"812224","DOI":"10.3389\/fonc.2022.812224","article-title":"Epstein-Barr Virus in Burkitt Lymphoma in Africa Reveals a Limited Set of Whole Genome and LMP-1 Sequence Patterns: Analysis of Archival Datasets and Field Samples From Uganda, Tanzania, and Kenya","volume":"12","author":"Liao","year":"2022","journal-title":"Front. Oncol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1097\/QAD.0000000000002839","article-title":"Prospective evaluation of blood Epstein\u2013Barr virus DNA load and antibody profile in HIV-related non-Hodgkin lymphomas","volume":"35","author":"Lupo","year":"2021","journal-title":"AIDS"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"112392","DOI":"10.1016\/j.biopha.2021.112392","article-title":"Lessons from Epstein-Barr virus DNA detection in cerebrospinal fluid as a diagnostic tool for EBV-induced central nervous system dysfunction among HIV-positive patients","volume":"145","author":"Wang","year":"2022","journal-title":"Biomed. Pharmacother."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1016\/S1473-3099(02)00317-1","article-title":"Synergism between HIV and other viruses in the mouth","volume":"2","author":"Teo","year":"2002","journal-title":"Lancet Infect. Dis."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/j.canep.2018.01.008","article-title":"First data from a population based cancer registry in Ethiopia","volume":"53","author":"Timotewos","year":"2018","journal-title":"Cancer Epidemiol."}],"container-title":["Viruses"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1999-4915\/15\/8\/1743\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:33:51Z","timestamp":1760128431000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1999-4915\/15\/8\/1743"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,15]]},"references-count":47,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2023,8]]}},"alternative-id":["v15081743"],"URL":"https:\/\/doi.org\/10.3390\/v15081743","relation":{},"ISSN":["1999-4915"],"issn-type":[{"value":"1999-4915","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8,15]]}}}