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Epstein–Barr virus (EBV) infects over 95% of people worldwide. Although primary infection is usually asymptomatic, it is linked to a wide range of diseases, including cancers, autoimmune diseases, and neurodegenerative diseases. This review looks at the various clinical outcomes associated with EBV infection. It highlights the established role of EBV in cancer development and its strong associations with autoimmune diseases. It also discusses new evidence linking EBV to neurodegenerative diseases, specifically Alzheimer’s disease. A key focus of this review is how biological sex influences EBV-associated disease outcomes. We explore how sex chromosomes, X-chromosome inactivation, sex hormones, and sex-specific immune responses explain the significant differences between women and men in their susceptibility to autoimmune diseases, neurodegeneration, and EBV-related cancers. By bringing together evidence from these disease categories, this review emphasizes biological sex as an important yet often overlooked factor in the differences seen in EBV-associated diseases and points out critical areas that need more detailed research.
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Onisiforou et al. (2026) studied this question.
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