Countries and centresNon-Hodgkin lymphoma (all types)

The mechanism now has a name. Repeated falciparum infection drives polyclonal B-cell activation, raising the chance of an activation-induced cytidine deaminase mediated MYC translocation in proportion to the recurrent parasite burden; Rochford and Mbulaiteye call the result a tumour of malaria survivors, peaking years after the age of highest malaria mortality, and say plainly that malaria control is a form of cancer control. The strongest evidence for that direction of causation is an experiment nobody designed. A 2024 systematic review and meta-analysis of 5,226 Burkitt cases from 17 countries found rates 44 percent lower (95 percent confidence interval 12 to 64) after insecticide-treated bed nets were introduced than before, with pooled incidence of 1.36 per 100,000 person-years before and 0.76 after; each percentage point of bed-net use in the preceding decade was associated with a 2 percent reduction in incidence. The absolute rates are small and the denominators are not all the same, which is a trap. Northern Uganda, the classic focus, had an age-standardised incidence of 2.4 per 100,000, rising to 4.1 in 5 to 9 year olds and varying three to fourfold between districts. Mozambique's 2015 estimates were 2.0, 1.7 and 3.9 per million person-years in three regions, highest in the north where malaria transmission is most intense: that is per million, not per 100,000. Papua New Guinea's national figure, the newest that could be found and now twenty-one years old, was 1.7 per 100,000 with 13.4 per 100,000 in Gulf province, and 89 percent of cases came from the malaria-holoendemic coast. For contrast, the United States rate across 11,626 SEER cases was 3.96 per million person-years. Epstein-Barr virus is in 45.8 percent of Burkitt lymphoma worldwide (95 percent confidence interval 35.2 to 56.8), and Burkitt was the only subtype in that global meta-analysis with real regional heterogeneity in EBV positivity, with near-universal positivity in East African cases.

• Burkitt D, A sarcoma involving the jaws in African children, British Journal of Surgery 1958. The citation is verified; Europe PMC carries no abstract and nothing is quoted from it here (1958)
• Burkitt D, Determining the climatic limitations of a children's cancer common in Africa, BMJ 1962 (1962)
• Cook-Mozaffari P, Newton R, Beral V and Burkitt DP, The geographical distribution of Kaposi's sarcoma and of lymphomas in Africa before the AIDS epidemic, British Journal of Cancer 1998 (1998)
• Rochford R and Mbulaiteye SM, The complex interplay of malaria and EBV in Burkitt lymphoma, Cancers 2026 (2026)
• Moormann AM, Bailey JA and Rochford R, Burkitt Lymphoma, Current Topics in Microbiology and Immunology 2025 (2025)
• Schmit N, Kaur J and Aglago EK, Mosquito bed net use and Burkitt lymphoma incidence in sub-Saharan Africa: a systematic review and meta-analysis, JAMA Network Open 2024 (2024)
• Ogwang MD, Bhatia K, Biggar RJ and Mbulaiteye SM, Incidence and geographic distribution of endemic Burkitt lymphoma in northern Uganda revisited, International Journal of Cancer 2008 (2008)
• O'Callaghan-Gordo C et al, Incidence of endemic Burkitt lymphoma in three regions of Mozambique, American Journal of Tropical Medicine and Hygiene 2016 (2016)
• Lavu E et al, Burkitt lymphoma in Papua New Guinea, 40 years on, Annals of Tropical Paediatrics 2005. The newest Papua New Guinea figures that could be found (2005)
• Mburu W, Devesa SS, Check D, Shiels MS and Mbulaiteye SM, Incidence of Burkitt lymphoma in the United States during 2000 to 2019, International Journal of Cancer 2023 (2023)
• Hirabayashi M, Georges D, Combes JD and Clifford GM, Attributable fraction of Epstein-Barr virus in subtypes of lymphoma: a systematic review and global meta-analysis, International Journal of Cancer 2026 (2026)

No five-year survival figure for Burkitt lymphoma in sub-Saharan Africa could be found. What exists is one-year survival, and setting a high-income five-year cure rate against an African one-year figure would be comparing different things, so both endpoints are named here. Cameroon: 934 patients treated with cyclophosphamide and intrathecal methotrexate, a protocol chosen because it is affordable and deliverable. Overall one-year survival 53.45 percent, by stage 77.1 percent for stage I, 67.9 for stage II, 55.1 for stage III and 32.4 for stage IV. The median delay from first symptom to diagnosis was 31 days and 71.5 percent presented at stage III. Tanzania: 72 children at two tertiary hospitals, one-year post-treatment survival 75 percent overall, but complete remission was 61.3 percent at one hospital and 36.6 percent at the other, with treatment abandonment at 22.0 percent against 3.2 percent. The authors say in terms that a one-year figure cannot be compared with the WHO Global Initiative for Childhood Cancer's 2030 target, which is five-year survival. The one randomised answer to the gap is rituximab. In East Africa, children with EBV-positive Burkitt lymphoma given rituximab with the standard cyclophosphamide, vincristine and methotrexate backbone had 12-month event-free survival of 67 percent against 43 percent without it, hazard ratio 0.49, with 8 deaths against 16 and no excess of serious adverse events. Rituximab is already on the WHO Model List of Essential Medicines for Burkitt lymphoma, so the gap is supply and system rather than listing. Tumour lysis syndrome is the other gap and it kills quickly. An Indian centre reported 17 of its children developing it and 6 of 22 deaths attributable to it, achieving four-year event-free survival of 72.9 percent with judicious use of single-dose rasburicase and modified-dose methotrexate: the resources that make the difference are a laboratory, dialysis and one expensive injection, not a new drug.

• Lap CJ and Dunleavy K, Novel molecular insights and evolution of less toxic therapeutic strategies in Burkitt lymphoma, Cancers 2025 (2025)
• Hesseling PB et al, Burkitt lymphoma: the effect of age, sex and delay to diagnosis on treatment completion and outcome of treatment in 934 patients in Cameroon, PLoS One 2024 (2024)
• Nkya H et al, Childhood Burkitt lymphoma: treatment outcomes, survival, and mortality predictors at two tertiary hospitals in Tanzania, BMC Pediatrics 2026 (2026)
• Mawalla WF et al, Rituximab for children with EBV-positive Burkitt lymphoma in East Africa, Blood Advances 2025 (2025)
• Nirmal G et al, Resource-adapted strategies in the management of paediatric Burkitt lymphoma in a low- and middle-income country setting and outcomes: an Indian centre experience, British Journal of Haematology 2025 (2025)
• World Health Organization: the selection and use of essential medicines 2025, WHO Model List of Essential Medicines, 24th list. Asparaginase and pegaspargase are listed on the complementary list for acute lymphoblastic leukaemia only; the words NK/T and natural killer appear nowhere in the document (2025)
• Wang M et al, Global incidence of childhood cancer by subtype in 2022: a population-based registry study, EClinicalMedicine 2025 (2025)

The attributable fraction settles the virology. In HIV-negative people, Epstein-Barr virus is present in 92.4 percent of extranodal NK/T-cell lymphoma (95 percent confidence interval 83.3 to 96.7), the highest of any lymphoma subtype measured in a global meta-analysis of 307 studies, against 53.0 percent for Hodgkin lymphoma, 45.8 percent for Burkitt and 10.8 percent for diffuse large B-cell lymphoma. True incidence rates barely exist outside two places, which is a caution rather than a detail. Taiwan's cancer registry recorded 872 new diagnoses between 2008 and 2021, with age-specific rates falling from 0.46 to 0.32 per 100,000 person-years at ages 45 to 64. The United States rate across SEER is 0.067 per 100,000. Everywhere else in east Asia and Latin America the literature reports the disease as a percentage of lymphomas, not as a rate: 11.0 percent of 4,638 lymphoid neoplasms in a Chinese series, 2.2 percent in the developing-world arm of the International Non-Hodgkin Lymphoma Classification Project against a much lower share in the developed world. A proportion is not a rate, and it confounds this disease's frequency with the local mix of everything else. The ethnic gradient inside one country is the hardest comparison available. In the United States, incidence was 0.132 to 0.157 per 100,000 in non-Hispanic Asian or Pacific Islander and Hispanic populations against around 0.03 per 100,000 in non-Hispanic White and non-Hispanic Black populations: a four to fivefold difference within one health system. It is often said that the Latin American excess reflects Indigenous American ancestry, and that may be so, but no study has measured genomic ancestry fractions against this lymphoma's risk. What exists is registry ethnicity categories and case-series proportions, and that is what is said here. The Latin American case-series picture is clear enough on its own. In 1,979 peripheral T-cell lymphomas across Latin America, extranodal NK/T-cell lymphoma was 15 percent of the total, rising to 41 percent of peripheral T-cell lymphomas in Central America and the Caribbean and 31 percent in Mexico. A mutational study of 71 Latin American cases from Mexico, Peru and Argentina found STAT3 the commonest mutated gene at 23 percent, and most tumours carrying type A Epstein-Barr virus without the 30-base-pair LMP1 deletion. A separate genome study of 217 EBV isolates from Guatemala, Peru, Malawi and Taiwan found that variants previously called cancer-type-specific are more closely tied to geographic origin than to histology, which is a warning about every EBV variant association in the literature.

• Hirabayashi M, Georges D, Combes JD and Clifford GM, Attributable fraction of Epstein-Barr virus in subtypes of lymphoma: a systematic review and global meta-analysis, International Journal of Cancer 2026 (2026)
• Yeh SA et al, Trends in the incidence of the Epstein-Barr virus-associated malignancies extranodal NK/T-cell lymphoma and nasopharyngeal carcinoma in Taiwan, PLoS One 2024 (2024)
• Zhao Y et al, Incidence, prognostic factors, and treatment impact on survival in natural killer/T-cell lymphoma: a population-based study in the United States, JMIR Formative Research 2025 (2025)
• Sun J et al, Distribution of lymphoid neoplasms in China: analysis of 4,638 cases according to the World Health Organization classification, American Journal of Clinical Pathology 2012 (2012)
• Perry AM et al, Non-Hodgkin lymphoma in the developing world: review of 4,539 cases from the International Non-Hodgkin Lymphoma Classification Project, Haematologica 2016 (2016)
• Vose J, Armitage J and Weisenburger D, International peripheral T-cell and natural killer/T-cell lymphoma study: pathology findings and clinical outcomes, Journal of Clinical Oncology 2008 (2008)
• Au WY et al, Clinical differences between nasal and extranasal natural killer/T-cell lymphoma: a study of 136 cases from the International Peripheral T-Cell Lymphoma Project, Blood 2009 (2009)
• Haverkos BM et al, Extranodal NK/T-cell lymphoma, nasal type: an update on epidemiology, clinical presentation and natural history in North American and European cases, Current Hematologic Malignancy Reports 2016 (2016)
• Malpica L et al, Epidemiology, clinical features, and outcomes of peripheral T-cell lymphoma in Latin America: an international, retrospective, cohort study, Lancet Haematology 2025 (2025)
• Montes-Mojarro IA et al, Mutational profile and EBV strains of extranodal NK/T-cell lymphoma, nasal type, in Latin America, Modern Pathology 2020 (2020)
• Briercheck EL et al, Geographic EBV variants confound disease-specific variant interpretation and predict variable immune therapy responses, Blood Advances 2024 (2024)
• Chabay P et al, Lymphotropic viruses EBV, KSHV and HTLV in Latin America: epidemiology and associated malignancies, a literature-based study by the RIAL-CYTED, Cancers 2020 (2020)

The evidence is consistent across three continents. SMILE, the Japanese phase II study that established the approach, gave an overall response rate of 79 percent and one-year overall survival of 55 percent in stage IV, relapsed or refractory disease, at the cost of grade 4 neutropenia in 92 percent and a protocol amendment after the first two patients died of infection. P-GEMOX, pegaspargase with gemcitabine and oxaliplatin, gave an 88.8 percent response rate in 117 patients with three-year overall survival of 72.7 percent. A Chinese randomised comparison of DDGP against SMILE in 42 patients favoured DDGP on every endpoint, though 42 patients is a small trial and that has been said in print. In early-stage disease given with radiotherapy, a Chinese cooperative group analysis of 376 patients found asparaginase-based regimens improved five-year overall survival to 84.5 percent against 73.2 percent in intermediate and high-risk patients. Japan's NKEA-Next study of advanced disease found two-year overall survival of 57.1 percent with SMILE, 35.8 percent with DeVIC and zero percent with CHOP. Now the list. The 24th WHO Model List of Essential Medicines, published in 2025, carries asparaginase and pegaspargase on its complementary list with one indication each: acute lymphoblastic leukaemia. The lymphoma indications named anywhere in the document are anaplastic large cell lymphoma, Burkitt lymphoma, diffuse large B-cell lymphoma, follicular lymphoma and Hodgkin lymphoma. The words NK/T and natural killer do not appear in the document at all, and nor does adult T-cell leukaemia/lymphoma. The United States label for pegaspargase likewise carries only acute lymphoblastic leukaemia indications. So the drug that makes this disease curable is, formally, an off-label use everywhere, and it is not on the list that national essential medicines lists are built from. The practical consequence is documented for asparaginase generally rather than for this lymphoma: short shelf lives, intermittent availability and concern about substandard formulations in low- and middle-income countries, and universal availability of top childhood cancer medicines reported by 9 to 46 percent of respondents in low-income countries against 67 to 100 percent in high-income ones. No paper documenting pegaspargase unavailability for NK/T-cell lymphoma specifically in a low-income setting could be found, and that absence is itself worth recording.

• Yamaguchi M et al, Phase II study of SMILE chemotherapy for newly diagnosed stage IV, relapsed or refractory extranodal natural killer/T-cell lymphoma, nasal type: the NK-Cell Tumor Study Group study, Journal of Clinical Oncology 2011 (2011)
• Wang JH et al, Analysis of the efficacy and safety of a combined gemcitabine, oxaliplatin and pegaspargase regimen for NK/T-cell lymphoma, Oncotarget 2016 (2016)
• Li X et al, DDGP versus SMILE in newly diagnosed advanced natural killer/T-cell lymphoma: a randomized controlled, multicenter, open-label study in China (42 patients) (2016)
• Zheng X et al, Association of improved overall survival with decreased distant metastasis following asparaginase-based chemotherapy and radiotherapy for intermediate- and high-risk early-stage extranodal nasal-type NK/T-cell lymphoma: a CLCG study, ESMO Open 2021 (2021)
• Fujimoto A et al, Improved prognosis of advanced-stage extranodal NK/T-cell lymphoma: results of the NKEA-Next study, Leukemia 2025 (2025)
• World Health Organization: the selection and use of essential medicines 2025, WHO Model List of Essential Medicines, 24th list. Asparaginase and pegaspargase are listed on the complementary list for acute lymphoblastic leukaemia only; the words NK/T and natural killer appear nowhere in the document (2025)
• Hughes TM et al, Forecasting asparaginase need and cost for childhood cancer using ACCESS FORxECAST, JCO Global Oncology 2025 (2025)
• Denburg AE et al, Access to essential medicines for children with cancer: a global survey, JCO Global Oncology 2022 (2022)

The landmark estimate, from 2012, puts the global figure at five to ten million, but says so with an explicit caveat that it rests on about 1.5 billion people in areas with reliable data and that correct estimates for China, India, the Maghreb and East Africa are not currently possible: the true number is probably higher. The primary-source figures that could be verified are these. Central Australia: 197 of 510 adults in a community survey, 38.6 percent, were infected. French Guiana: 3.1 percent of 1,078 Creoles tested in 1998, with 137 confirmed adult T-cell leukaemia/lymphoma cases over thirty years, 69 percent of them Maroons, median age at diagnosis 43 among Maroons against 58 among Creoles. North-eastern Iran: 2.73 percent in a rural population of Afghan origin near Mashhad. Japan: at least 1.08 million carriers estimated in 2006 to 2007. Romania is the only genuine endemic focus in Europe, and the virus there traces phylogenetically to southern Africa. Several widely quoted figures, including a Jamaican prevalence of about 6.1 percent, 800,000 carriers in Brazil and two to five million in sub-Saharan Africa, come only from a 2026 narrative review's collation of other people's work and have not been traced to their primaries here. The lifetime risk figure every clinician quotes is old. It is 4 to 6 percent for men and 2.6 percent for women, and it comes from studies published in 1989, 1990 and 2000. The 2020 Japanese review that quotes it says explicitly that there has been no other study to update the lifetime risk of adult T-cell leukaemia/lymphoma among carriers in the general Japanese population. Any number on this page is roughly thirty-five years old and that should be said whenever it is used. Survival depends almost entirely on the Shimoyama subtype. The 1991 classification of 818 patients gave median survival of 6.2 months for acute, 10.2 for lymphoma, 24.3 for chronic and not reached for smouldering disease. A modern Japanese series of 1,594 patients gave 8.3, 10.6, 31.5 and 55.0 months and four-year overall survival of 11, 16, 36 and 52 percent, with the authors noting that the smouldering type did worse than expected. In the United States, a cohort of 195 patients, 77 percent Afro-Caribbean, gave 4.1 months for acute and 10.2 for lymphomatous disease. Peru's thirty-year series of 116 cases gave 6.5, 12.5 and 89.6 months for acute, lymphomatous and smouldering or chronic disease, and found that only 13.8 percent of patients knew they had HTLV-1 before the lymphoma, and only 8 of those through routine screening. Latin America's concentration is extraordinary. Among 1,963 mature T-cell lymphomas pooled across the region, adult T-cell leukaemia/lymphoma was 17 percent of the total, 38 percent in Peru and 29 percent in Colombia, and in Peru the share rose from 14 percent in 2000 to 2004 to 58 percent in 2019 to 2023.

• Gessain A and Cassar O, Epidemiological aspects and world distribution of HTLV-1 infection, Frontiers in Microbiology 2012 (2012)
• Noori B et al, Epidemiology and clinical outcomes of HTLV-1: a comprehensive narrative review of endemic and non-endemic regions, Canadian Journal of Infectious Diseases and Medical Microbiology 2026. A narrative review: its regional figures are its collation of other people's numbers, and are labelled as such here (2026)
• Iwanaga M, Epidemiology of HTLV-1 infection and ATL in Japan: an update, Frontiers in Microbiology 2020 (2020)
• Ito S et al, Epidemiology of adult T-cell leukemia-lymphoma in Japan: an updated analysis, 2012 to 2013, Cancer Science 2021 (2021)
• Talukder MR et al, High human T-cell leukemia virus type 1c proviral loads are associated with diabetes and chronic kidney disease: results of a cross-sectional community survey in Central Australia, Clinical Infectious Diseases 2023 (2023)
• Ramassamy JL et al, Adult T-cell leukemia/lymphoma in French Guiana 1990 to 2019: epidemiology, clinical features, and HTLV-1 genetic diversity in the two main ethnic populations, International Journal of Cancer 2026 (2026)
• Mahdifar M et al, Immigrating and vicinity are not risk factors in the prevalence and transmission rate of human T-lymphotropic virus type 1: a survey in an endemic region of Iran and Afghan refugees, PLOS Global Public Health 2023 (2023)
• Paun L et al / Southern African origin of HTLV-1 in Romania: the only genuine endemic region for HTLV-1 in Europe (2017)
• Shimoyama M, Diagnostic criteria and classification of clinical subtypes of adult T-cell leukaemia-lymphoma: a report from the Lymphoma Study Group (1984 to 1987), British Journal of Haematology 1991 (1991)
• Katsuya H et al, Treatment and survival among 1,594 patients with ATL, Blood 2015 (2015)
• Malpica L et al, Epidemiology, clinical features, and outcome of HTLV-1-related ATLL in an area of prevalence in the United States, Blood Advances 2018 (2018)
• Garrido-Pinzas G et al, Epidemiology of adult T-cell leukemia/lymphoma in people living with HTLV-1: a 30-year study in Peru, PLOS Neglected Tropical Diseases 2026 (2026)
• Valcarcel B et al, Prevalence and survival outcomes of adult T-cell leukemia/lymphoma in Latin America: a multicenter cohort study and recommendations to improve diagnosis and outcomes, Cancer Epidemiology 2025 (2025)

The first demonstration was six patients in 1993: Helicobacter was eradicated in all of them and repeated biopsies showed no lymphoma in five. The pooled figure, from a 2023 meta-analysis of 61 studies and 2,936 patients, is a complete response rate of 75.18 percent (95 percent confidence interval 70.45 to 79.91) in Helicobacter-positive early-stage gastric MALT lymphoma, with no significant difference between Asian and Western series. The largest long-term cohort, 420 Japanese patients, had 77 percent respond and, at ten years, 90 percent free of treatment failure, 95 percent alive and 86 percent event-free. The translocation t(11;18)(q21;q21), now written BIRC3::MALT1, predicts a poorer chance of responding. The 2001 Lancet paper found it in nine of twelve non-responders and in none of the responders; the 2002 follow-up found it in 42 of 63 non-responsive cases and in 2 of 48 complete regressions. It is not a reason to skip the antibiotics. Both studies contained translocation-positive patients who did respond, and the current expert view is that antibiotic eradication is the recommended therapy of choice irrespective of genetic findings, with molecular analysis not required before starting. The geography is real but the rates are sparse. A 1992 Lancet study found thirteen times more primary gastric lymphoma in Feltre in north-eastern Italy than in comparison UK communities, 66 against 5 per 100,000 per five years. A Dutch nationwide study put incidence at 0.41 per 100,000 a year. The translocation is commoner in Asia, and marginal zone lymphoma is the commonest indolent B-cell lymphoma diagnosed in China and Korea. No population incidence rate for gastric MALT lymphoma could be found for Korea, Japan or anywhere in Latin America: what exists there is hospital-series proportions, which are not rates. The prevalence is falling and so is the lymphoma. Global Helicobacter prevalence fell from 58.2 percent in 1980 to 1990 to 43.1 percent in 2011 to 2022. In Modena, Italy, gastric MALT lymphoma incidence fell from 1.4 to 0.2 per 100,000 between 1997 and 2002, an annual percentage change of minus 17.0 percent, and the proportion of cases associated with Helicobacter fell from 61 to 17 percent. This is one of the few cancers in the world that is disappearing because of a public health change aimed at something else.

• Hooi JKY et al, Global prevalence of Helicobacter pylori infection: systematic review and meta-analysis, Gastroenterology 2017 (2017)
• Li Y et al, Global prevalence of Helicobacter pylori infection between 1980 and 2022: a systematic review and meta-analysis, Lancet Gastroenterology and Hepatology 2023 (2023)
• Wotherspoon AC et al, Regression of primary low-grade B-cell gastric lymphoma of mucosa-associated lymphoid tissue type after eradication of Helicobacter pylori, Lancet 1993 (1993)
• Lemos FFB et al, Effectiveness of Helicobacter pylori eradication in the treatment of early-stage gastric mucosa-associated lymphoid tissue lymphoma: an up-to-date meta-analysis, World Journal of Gastroenterology 2023 (2023)
• Nakamura S et al, Long-term clinical outcome of gastric MALT lymphoma after eradication of Helicobacter pylori: a multicentre cohort follow-up study of 420 patients in Japan, Gut 2012 (2012)
• Liu H et al, Resistance of t(11;18) positive gastric mucosa-associated lymphoid tissue lymphoma to Helicobacter pylori eradication therapy, Lancet 2001 (2001)
• Liu H et al, t(11;18)(q21;q21) is associated with advanced mucosa-associated lymphoid tissue lymphoma that expresses nuclear BCL10, Gastroenterology 2002 (2002)
• Raderer M, Kiesewetter B and Du MQ, Clinical relevance of molecular aspects in extranodal marginal zone lymphoma: a critical appraisal, Therapeutic Advances in Medical Oncology 2023. Antibiotic eradication is the recommended therapy of choice irrespective of genetic findings (2023)
• Doglioni C et al, High incidence of primary gastric lymphoma in northeastern Italy, Lancet 1992 (1992)
• Capelle LG et al, Gastric MALT lymphoma: epidemiology and high adenocarcinoma risk in a nation-wide study, European Journal of Cancer 2008 (2008)
• Luminari S et al, Decreasing incidence of gastric MALT lymphomas in the era of anti-Helicobacter pylori interventions: results from a population-based study on extranodal marginal zone lymphomas, Annals of Oncology 2010 (2010)

Across 448,258 people with HIV in the United States, the standardised incidence ratio was 11.5 for non-Hodgkin lymphoma and 7.70 for Hodgkin lymphoma, and by subtype it was 10.3 for diffuse large B-cell lymphoma, 20.2 for Burkitt lymphoma, and 153 for central nervous system non-Hodgkin lymphoma: a 153-fold excess, the largest for any cancer in that study. What combination antiretroviral therapy did is uneven, and the unevenness is the point. Between 1990 to 1995 and 1996 to 2002, the standardised incidence ratio for non-Hodgkin lymphoma in people with AIDS in the United States fell from 53.2 to 22.6, while the ratio for Hodgkin lymphoma rose from 8.1 to 13.6. In the later study, trends declined significantly for Kaposi sarcoma, diffuse large B-cell lymphoma and central nervous system lymphoma, and were not significant for Burkitt lymphoma, cervical cancer or Hodgkin lymphoma. Treating the immune deficiency removed most of the lymphomas that depend on profound immunosuppression and left the ones that do not. Survival still splits by subtype: five-year survival of 61.6 percent for Hodgkin lymphoma, 50.0 for Burkitt, 44.1 for diffuse large B-cell, 43.3 for other non-Hodgkin lymphoma and 22.8 for primary central nervous system lymphoma. Across five continents and 210,898 adults with HIV, South African women remained at higher risk of non-Hodgkin lymphoma than their European counterparts after adjustment, hazard ratio 1.79. The treatment side has one landmark. The first completed trial of diffuse large B-cell lymphoma treatment in sub-Saharan Africa, in Malawi with 37 patients, reported overall survival of 68 percent at twelve months and 55 percent at twenty-four, with treatment-related mortality of 11 percent. That is what a modern regimen achieves where it can be delivered. And the access figures that sit underneath all of it: in 2025, 78 percent of all people living with HIV were accessing treatment globally, 85 percent in eastern and southern Africa, 74 percent in western and central Africa, 56 percent in eastern Europe and central Asia and 53 percent in the Middle East and North Africa. For children aged 0 to 14 the numbers are far worse: 41 percent in western and central Africa, 33 percent in the Caribbean, 30 percent in the Middle East and North Africa. UNAIDS also records that total international resources for the HIV response fell by 18 percent, the largest decline in almost two decades. Two lymphomas on this map depend on a different virus. Primary effusion lymphoma, driven by Kaposi sarcoma herpesvirus, occurs more than 700 times as often in people with HIV as in the general population, with five-year overall survival of 44.5 percent in people with HIV and 15.2 percent in people without. HHV-8 multicentric Castleman disease carries a non-Hodgkin lymphoma incidence about fifteen times that expected in the HIV-positive population. The seroprevalence map for that virus is a genuine blank: it was 35.5 percent by age 21 in Uganda against 13.7 percent in Zimbabwe and 10.8 percent in South Africa, and almost half of African countries have no data at all. No reliable pooled global figure exists, because the assays are not comparable.

• Hernandez-Ramirez RU et al, Cancer risk in HIV-infected people in the USA from 1996 to 2012: a population-based, registry-linkage study, Lancet HIV 2017 (2017)
• Engels EA et al, Trends in cancer risk among people with AIDS in the United States 1980 to 2002, AIDS 2006 (2006)
• Gopal S et al, Temporal trends in presentation and survival for HIV-associated lymphoma in the antiretroviral therapy era, Journal of the National Cancer Institute 2013 (2013)
• AIDS-defining Cancer Project Working Group of IeDEA and COHERE in EuroCoord, Non-Hodgkin lymphoma risk in adults living with HIV across five continents, AIDS 2018 (2018)
• Kimani S et al, Safety and efficacy of rituximab in patients with diffuse large B-cell lymphoma in Malawi: a prospective, single-arm, non-randomised phase 1/2 clinical trial, Lancet Global Health 2021 (2021)
• UNAIDS global HIV statistics fact sheet, 2025 data. The HTML fact sheet page carries no regional numbers; these were read from the PDF (2026-07)
• Volesky-Avellaneda KD et al, Primary effusion lymphoma in people with and without HIV infection in the United States, AIDS 2025 (2025)
• Dollard SC et al, Substantial regional differences in human herpesvirus 8 seroprevalence in sub-Saharan Africa, International Journal of Cancer 2010 (2010)
• Etta EM et al, Human herpesvirus 8 seroprevalence and genotypes in Africa: almost half the countries have no data at all (2018)

Computed from the GLOBOCAN 2022 country file in this repository: for non-Hodgkin lymphoma the ratio of age-standardised mortality to age-standardised incidence is 0.16 in Denmark, 0.20 in the United States, 0.22 in Australia, 0.25 in the United Kingdom, Italy and France, 0.27 in Japan and 0.29 in Canada. It is 0.58 in India and South Africa, 0.62 in Viet Nam, 0.63 in Malawi, 0.69 in Ethiopia, 0.72 in Kenya, Nigeria and Zimbabwe, 0.75 in Uganda and Tanzania and 0.77 in Mozambique. For Hodgkin lymphoma, the most curable common cancer in the world, the same calculation is starker: 0.06 in the United States and Australia, 0.07 in Canada, France and Germany, 0.08 in the United Kingdom and Denmark, 0.09 in Italy, Israel and Korea. And then 0.26 in South Africa, 0.35 in China, 0.37 in India, 0.47 in Nigeria, 0.49 in Kenya and Malawi, 0.54 in Mozambique, 0.58 in Uganda and 0.70 in Tanzania. A disease that almost nobody in western Europe dies of still kills a large share of the people who get it in east Africa. Globally, GLOBOCAN 2022 put non-Hodgkin lymphoma at 553,389 new cases and 250,679 deaths, and Hodgkin lymphoma at 82,469 cases and 22,733 deaths. The 2024 vintage, published in 2026, puts non-Hodgkin lymphoma at 562,793 cases and 234,903 deaths and Hodgkin lymphoma at 84,495 and 19,515. Asia carries 44.5 percent of the world's non-Hodgkin lymphoma cases and Europe 22.9 percent. Two warnings travel with any ranking here. IARC grades its own estimates, and a country's rate may be modelled from national mortality using mortality-to-incidence ratios derived from registry data elsewhere: half the Hodgkin lymphoma incidence top ten are modelled this way, and the Hodgkin top ten reshuffles almost completely between the 2022 and 2024 vintages while the world total barely moves. Ranking countries by Hodgkin lymphoma incidence is not a safe thing to do, and this page does not do it. Second, the Global Burden of Disease study does not agree with GLOBOCAN: GBD 2021 gives 604,554 non-Hodgkin lymphoma cases and 267,061 deaths for the same world, and puts Peru top of every country for incidence at an age-standardised 24.00 per 100,000, which GLOBOCAN does not. No source explains the discrepancy, so it is reported rather than resolved. The Global Burden of Disease analysis does say the thing this section is about, in one sentence: high socio-demographic index regions had the highest age-standardised incidence but the fastest mortality declines, whereas low socio-demographic index areas had the highest age-standardised mortality and minimal improvement, with eastern sub-Saharan Africa at the peak.

• IARC Global Cancer Observatory, Cancer Today: GLOBOCAN estimates for non-Hodgkin lymphoma (C82-86, C88) and Hodgkin lymphoma (C81) (2026-10-01)
• IARC Cancer Today API v3, GLOBOCAN 2022 factsheet endpoint, one request per population; incidence rows are type 0 and mortality rows type 1, and the 185 country rows in this file were read from it (2026-10-01)
• IARC Global Cancer Observatory: GLOBOCAN 2024 non-Hodgkin lymphoma fact sheet (562,793 cases, ASR 5.4; 234,903 deaths, ASR 2.1) (2026-07-08)
• IARC Global Cancer Observatory: GLOBOCAN 2024 Hodgkin lymphoma fact sheet (84,495 cases, ASR 0.96; 19,515 deaths, ASR 0.19) (2026-07-08)
• Li T et al, The global, regional and national burden of non-Hodgkin lymphoma in 204 countries and territories and 811 subnational locations, 1990 to 2021, Annals of Hematology 2025 (2025)
• Li D et al, Global burden of non-Hodgkin lymphoma by socio-demographic index, Expert Review of Hematology 2025 (2025)
• Pu H, Zhang J and Song Y, Global burden of Hodgkin lymphoma, Annals of Hematology 2026 (2026)
• Allemani C et al, Global surveillance of trends in cancer survival 2000 to 2014 (CONCORD-3). Adults are analysed in two broad groups, lymphoid and myeloid malignancies, so the lymphoid figure bundles Hodgkin lymphoma, every non-Hodgkin subtype, myeloma and chronic lymphocytic leukaemia into one number (2018)