Exploring Epstein-Barr virus testing patterns and positivity rates: A retrospective analysis

Objectives: Epstein-Barr virus (EBV) is associated with a broad spectrum of clinical conditions. However, real-world data on EBV DNA testing patterns and positivity across clinical settings remain limited. We evaluated testing trends, clinical indications, EBV-DNA positivity rates, and viral load distribution across major clinical groups in a tertiary-care setting. Materials and Methods: We retrospectively analyzed EBV DNA testing data from 404 patients tested using whole blood at a tertiary-care center in North India between 2024 and 2025. Viral loads were quantified by real-time polymerase chain reaction. Testing indications, detection rates, and viral load distributions were evaluated across clinical subgroups. Statistical analysis: Categorical variables were compared using the χ 2 test or Fisher’s exact test. Normality was assessed using the Shapiro-Wilk test, followed by the Kruskal-Wallis test for multiple comparisons of viral load data. Results: EBV DNA was detected in 25.50% of cases. The highest positivity rate (36.84%) was observed among patients with secondary immunodeficiency, all of whom were human immunodeficiency virus (HIV) positive. Lymphoproliferative disorders constituted the largest referral group (26.48%), followed by renal transplant recipients (12.62%). Median viral loads were highest among HIV-positive patients (1.67 × 10 5 copies/mL) and renal transplant recipients (1.26 × 10 5 copies/mL). Conclusion: EBV-DNA testing was requested across diverse clinical settings, extending beyond traditionally recognized high-risk populations such as transplant recipients and patients with immunodeficiency. HIV-positive individuals showed the highest observed positivity rate and median viral load. These findings provide a real-world overview of EBV-DNA testing patterns and EBV DNAemia across diverse clinical populations.