Original Article | Epstein-Barr Virus Seroprevalence and Associated Risk Factors in Head and Neck Squamous Cell Carcinoma: A Cross-Sectional Study from Aden, Yemen.

Abstract

Background: Head and neck squamous cell carcinoma (HNSCC) incidence in Yemen shows distinct patterns, influenced by unique risk factors like qat chewing alongside tobacco, smoking, and viral infections. Epstein-Barr virus (EBV) is an established oncogenic virus, particularly for nasopharyngeal carcinoma (NPC). This study investigated EBV seroprevalence, infection status, and associations with demographic and risk factors in Yemeni HNSCC patients.

Methods: A cross-sectional study was conducted at the National Oncology Center, Aden, Yemen (Jan-Dec 2023). One hundred histologically confirmed HNSCC patients provided informed consent. Data on demographics, tumor characteristics (site, stage, histology), risk factors (tobacco, smoking, qat chewing, family history), and blood group were collected via records and questionnaires. EBV infection status (primary, past, reactivation) was determined using Chemiluminescent Immunoassay (CLIA) for EA IgG, NA IgG, VCA IgG, and VCA IgM.

Results: Patients had a mean age of 53.2 ± 14.7 years, with peaks in 36-54 (41%) and 55-73 (40%) years. Males predominated (M:F = 2.45:1). The nasopharynx was the most common site (48%). Most patients presented with advanced disease (Stage III: 57%, Stage IV: 29%). Qat chewing was the leading risk factor (74%), followed by tobacco use (68%) and cigarette smoking (50%), showing significant associations (p<0.05). EBV infection was highly prevalent: 8% primary, 39% past, 53% reactivation (p<0.001). CLIA positivity was high for VCA IgG (99%), NA IgG (88%), and EA IgG (61%). EA IgG positivity was significantly associated with infection status (p<0.001). Reactivation infection was strongly linked to NPC (66%). Blood group A was associated with increased NPC risk (52.0% of NPC patients).

Conclusion: This study highlights a high burden of EBV infection, particularly reactivation, among Yemeni HNSCC patients, with a striking predominance of NPC. Qat chewing emerges as a major local risk factor alongside tobacco and smoking. The association of EBV reactivation and blood group A with NPC underscores the virus's significant role in HNSCC pathogenesis within this population. These findings emphasize the need for EBV screening in HNSCC management and targeted public health interventions against modifiable risks like qat and tobacco in Yemen.