Patterns of incident Burkitt lymphoma during the HIV epidemic among the Black African and White population in South Africa.

Background: Burkitt lymphoma (BL) may be HIV-associated but data on BL trends in South Africa (SA), where HIV is highly prevalent, are scarce. We compared BL incidence trends over 36 years among Black African and White individuals.

Methods: We included histologically diagnosed BL from the National Cancer Registry in SA between 1986-2021. We computed yearly age-standardised incidence rates (ASIR) by race, and annual percentage changes in ASIR using Joinpoint regression.

Results: Between 1986-2021, 2205 Black African (ASIR: 1.68/1,000,000; 95% confidence interval [CI] 1.63-1.73) and 366 White individuals (ASIR: 2.34/1,000,000; 95% CI 2.15-2.53) had incident BL. Median age at diagnosis increased over time, while the male proportion among those diagnosed declined. The ASIR among Black Africans increased from 1986-2012 and declined thereafter with BL incidence peaks shifting from children and elderly to middle-aged adults. Among White individuals, BL rates rose among all age groups over time.

Conclusions: The BL epidemiology among Black Africans, with decreasing rates since 2012, may reflect SA's evolving HIV epidemic. In contrast, BL rates among White individuals in SA and many high-income countries continue to increase over time. Further studies are needed to better understand the differences in BL epidemiology across geographic regions and population groups.