Etiology of Hodgkin lymphoma (C81) in Central and South America

Epstein-Barr virus (EBV) is a herpes virus that is highly prevalent worldwide and the age at primary infection varies considerably. Exposure to EBV is related to indicators of low socioeconomic status (i.e., overcrowded living conditions and poor sanitation) [1]. In its evaluation of biological agents as human carcinogens, the International Agency for Research on Cancer concluded that there was sufficient evidence that EBV is a definite human carcinogen [1]. Strong mechanistic data support the oncogenic role of EBV in Hodgkin lymphoma and the mechanisms involved in the process include cell proliferation, inhibition of apoptosis, genomic instability, and cell migration [1]. EBV-associated malignancies may result from viral reactivation due to interactions with other co-factors [1]. Patients with Hodgkin lymphoma have been shown to have high levels of antibodies against EBV several years before its development [2], and predictors of strong associations between the pathogen and the disease are: young age (< 15 years) or older age (> 45 years), residence in a developing country, sex (male), nodular sclerosis, and mixed cellular histology [3].