Skip to main content
Erschienen in: Journal of NeuroVirology 3/2014

01.06.2014

HIV-associated distal neuropathic pain is associated with smaller total cerebral cortical gray matter

verfasst von: John R. Keltner, Christine Fennema-Notestine, Florin Vaida, Dongzhe Wang, Donald R. Franklin, Robert H. Dworkin, Chelsea Sanders, J. Allen McCutchan, Sarah L. Archibald, David J. Miller, George Kesidis, Clint Cushman, Sung Min Kim, Ian Abramson, Michael J. Taylor, Rebecca J. Theilmann, Michelle D. Julaton, Randy J. Notestine, Stephanie Corkran, Mariana Cherner, Nichole A. Duarte, Terry Alexander, Jessica Robinson-Papp, Benjamin B. Gelman, David M. Simpson, Ann C. Collier, Christina M. Marra, Susan Morgello, Greg Brown, Igor Grant, J. Hampton Atkinson, Terry L. Jernigan, Ronald J. Ellis, for the CHARTER Group

Erschienen in: Journal of NeuroVirology | Ausgabe 3/2014

Einloggen, um Zugang zu erhalten

Abstract

Despite modern antiretroviral therapy, HIV-associated sensory neuropathy affects over 50 % of HIV patients. The clinical expression of HIV neuropathy is highly variable: many individuals report few symptoms, but about half report distal neuropathic pain (DNP), making it one of the most prevalent, disabling, and treatment-resistant complications of HIV disease. The presence and intensity of pain is not fully explained by the degree of peripheral nerve damage, making it unclear why some patients do, and others do not, report pain. To better understand central nervous system contributions to HIV DNP, we performed a cross-sectional analysis of structural magnetic resonance imaging volumes in 241 HIV-infected participants from an observational multi-site cohort study at five US sites (CNS HIV Anti-Retroviral Treatment Effects Research Study, CHARTER). The association between DNP and the structural imaging outcomes was investigated using both linear and nonlinear (Gaussian Kernel support vector) multivariable regression, controlling for key demographic and clinical variables. Severity of DNP symptoms was correlated with smaller total cerebral cortical gray matter volume (r = −0.24; p = 0.004). Understanding the mechanisms for this association between smaller total cortical volumes and DNP may provide insight into HIV DNP chronicity and treatment-resistance.
Anhänge
Nur mit Berechtigung zugänglich
Literatur
Zurück zum Zitat Aksu Y, Miller DJ, Kesidis G, Yang QX (2010) Margin-maximizing feature elimination methods for linear and nonlinear kernel SVMs. IEEE Trans Neural Network 21(5):701–717CrossRef Aksu Y, Miller DJ, Kesidis G, Yang QX (2010) Margin-maximizing feature elimination methods for linear and nonlinear kernel SVMs. IEEE Trans Neural Network 21(5):701–717CrossRef
Zurück zum Zitat Apkarian AV, Sosa Y, Sonty S, Levy RM, Harden RN, Parrish TB, Gitelman DR (2004) Chronic back pain is associated with decreased prefrontal and thalamic gray matter density. J Neurosci 24:10410–10415PubMedCrossRef Apkarian AV, Sosa Y, Sonty S, Levy RM, Harden RN, Parrish TB, Gitelman DR (2004) Chronic back pain is associated with decreased prefrontal and thalamic gray matter density. J Neurosci 24:10410–10415PubMedCrossRef
Zurück zum Zitat Apkarian AV, Bushnell MC, Treede RD, Zubieta JK (2005) Human brain mechanisms of pain perception and regulation in health and disease. Eur J Pain 9:463–484PubMedCrossRef Apkarian AV, Bushnell MC, Treede RD, Zubieta JK (2005) Human brain mechanisms of pain perception and regulation in health and disease. Eur J Pain 9:463–484PubMedCrossRef
Zurück zum Zitat Baliki MN, Petre B, Torbey S, Herrmann KM, Huang L, Schnitzer TJ, Fields HL, Apkarian AV (2012) Corticostriatal functional connectivity predicts transition to chronic back pain. Nat Neurosci 15:1117–1119PubMedCentralPubMedCrossRef Baliki MN, Petre B, Torbey S, Herrmann KM, Huang L, Schnitzer TJ, Fields HL, Apkarian AV (2012) Corticostriatal functional connectivity predicts transition to chronic back pain. Nat Neurosci 15:1117–1119PubMedCentralPubMedCrossRef
Zurück zum Zitat Beck AT (1996) Beck depression inventory: manual. 2 ed. The Psychological Corporation Beck AT (1996) Beck depression inventory: manual. 2 ed. The Psychological Corporation
Zurück zum Zitat Borne J, Riascos R, Cuellar H, Vargas D, Rojas R (2005) Neuroimaging in drug and substance abuse part II: opioids and solvent. Top Magn Reson Imaging 16:239–245PubMedCrossRef Borne J, Riascos R, Cuellar H, Vargas D, Rojas R (2005) Neuroimaging in drug and substance abuse part II: opioids and solvent. Top Magn Reson Imaging 16:239–245PubMedCrossRef
Zurück zum Zitat Carey CL, Woods SP, Gonzalez R, Conover E, Marcotte TD, Grant I, Heaton RK, HNRC Group (2004) Predictive validity of global deficit scores in detecting neuropsychological impairment in HIV infection. J Clin Exp Neuropsychol 26:307–319PubMedCrossRef Carey CL, Woods SP, Gonzalez R, Conover E, Marcotte TD, Grant I, Heaton RK, HNRC Group (2004) Predictive validity of global deficit scores in detecting neuropsychological impairment in HIV infection. J Clin Exp Neuropsychol 26:307–319PubMedCrossRef
Zurück zum Zitat Cherry CL, Wesselingh SL, Lal L, McArthur JC (2005) Evaluation of a clinical screening tool for HIV-associated sensory neuropathies. Neurology 65:1778–1781PubMedCrossRef Cherry CL, Wesselingh SL, Lal L, McArthur JC (2005) Evaluation of a clinical screening tool for HIV-associated sensory neuropathies. Neurology 65:1778–1781PubMedCrossRef
Zurück zum Zitat Cohen J, Cohen P, West SG (2003) Applied multiple regression/correlation analysis for the behavioral sciences. 3rd ed. Erlbaum, London Cohen J, Cohen P, West SG (2003) Applied multiple regression/correlation analysis for the behavioral sciences. 3rd ed. Erlbaum, London
Zurück zum Zitat Dorsey SG, Morton PG (2006) HIV peripheral neuropathy: pathophysiology and clinical implications. AACN Clin Issues 17:30–36PubMedCrossRef Dorsey SG, Morton PG (2006) HIV peripheral neuropathy: pathophysiology and clinical implications. AACN Clin Issues 17:30–36PubMedCrossRef
Zurück zum Zitat Ellis RJ, Marquie-Beck J, Delaney P, Alexander T, Clifford DB, McArthur JC, Simpson DM, Ake C, Collier AC, Gelman BB, McCutchan JA, Morgello S, Grant I (2008) CHARTER Group: human immunodeficiency virus protease inhibitors and risk for peripheral neuropathy. Ann Neurol 64:566–572PubMedCentralPubMedCrossRef Ellis RJ, Marquie-Beck J, Delaney P, Alexander T, Clifford DB, McArthur JC, Simpson DM, Ake C, Collier AC, Gelman BB, McCutchan JA, Morgello S, Grant I (2008) CHARTER Group: human immunodeficiency virus protease inhibitors and risk for peripheral neuropathy. Ann Neurol 64:566–572PubMedCentralPubMedCrossRef
Zurück zum Zitat Ellis RJ, Rosario D, Clifford DB, McArthur JC, Simpson D, Alexander T, Gelman BB, Vaida F, Collier A, Marra CM, Ances B, Atkinson JH, Dworkin RH, Morgello S, Grant I (2010) CHARTER Study Group: continued high prevalence and adverse clinical impact of human immunodeficiency virus-associated sensory neuropathy in the era of combination antiretroviral therapy: the CHARTER Study. Arch Neurol 67:552–558PubMedCentralPubMedCrossRef Ellis RJ, Rosario D, Clifford DB, McArthur JC, Simpson D, Alexander T, Gelman BB, Vaida F, Collier A, Marra CM, Ances B, Atkinson JH, Dworkin RH, Morgello S, Grant I (2010) CHARTER Study Group: continued high prevalence and adverse clinical impact of human immunodeficiency virus-associated sensory neuropathy in the era of combination antiretroviral therapy: the CHARTER Study. Arch Neurol 67:552–558PubMedCentralPubMedCrossRef
Zurück zum Zitat Fennema-Notestine C, Gamst AC, Quinn BT, Pacheco J, Jernigan TL, Thal L, Buckner R, Killiany R, Blacker D, Dale AM, Fischl B, Dickerson B, Gollub RL (2007) Feasibility of multi-site clinical structural neuroimaging studies of aging using legacy data. Neuroinformatics 5:235–245PubMedCrossRef Fennema-Notestine C, Gamst AC, Quinn BT, Pacheco J, Jernigan TL, Thal L, Buckner R, Killiany R, Blacker D, Dale AM, Fischl B, Dickerson B, Gollub RL (2007) Feasibility of multi-site clinical structural neuroimaging studies of aging using legacy data. Neuroinformatics 5:235–245PubMedCrossRef
Zurück zum Zitat Geibprasert S, Gallucci M, Krings T (2010) Alcohol-induced changes in the brain as assessed by MRI and CT. Eur Radiol 20:1492–1501PubMedCrossRef Geibprasert S, Gallucci M, Krings T (2010) Alcohol-induced changes in the brain as assessed by MRI and CT. Eur Radiol 20:1492–1501PubMedCrossRef
Zurück zum Zitat Grieve SM, Korgaonkar MS, Koslow SH, Gordon E, Williams LM (2013) Widespread reductions in gray matter volume in depression. Neuroimage Clin 3:332–339PubMedCentralPubMedCrossRef Grieve SM, Korgaonkar MS, Koslow SH, Gordon E, Williams LM (2013) Widespread reductions in gray matter volume in depression. Neuroimage Clin 3:332–339PubMedCentralPubMedCrossRef
Zurück zum Zitat Gwilym SE, Filippini N, Douaud G, Carr AJ, Tracey I (2010) Thalamic atrophy associated with painful osteoarthritis of the hip is reversible after arthroplasty: a longitudinal voxel-based morphometric study. Arthritis Rheum 62:2930–2940PubMedCrossRef Gwilym SE, Filippini N, Douaud G, Carr AJ, Tracey I (2010) Thalamic atrophy associated with painful osteoarthritis of the hip is reversible after arthroplasty: a longitudinal voxel-based morphometric study. Arthritis Rheum 62:2930–2940PubMedCrossRef
Zurück zum Zitat Herrmann DN, McDermott MP, Henderson D, Chen L, Akowuah K, Schifitto G, North East AIDS (2004) Dementia (NEAD) Consortium: epidermal nerve fiber density, axonal swellings and QST as predictors of HIV distal sensory neuropathy. Muscle Nerve 29:420–427PubMedCrossRef Herrmann DN, McDermott MP, Henderson D, Chen L, Akowuah K, Schifitto G, North East AIDS (2004) Dementia (NEAD) Consortium: epidermal nerve fiber density, axonal swellings and QST as predictors of HIV distal sensory neuropathy. Muscle Nerve 29:420–427PubMedCrossRef
Zurück zum Zitat Jernigan TL, Gamst AC, Archibald SL, Fennema-Notestine C, Mindt MR, Marcotte TD, Heaton RK, Ellis RJ, Grant I (2005) Effects of methamphetamine dependence and HIV infection on cerebral morphology. Am J Psychiatry 162:1461–1472PubMedCrossRef Jernigan TL, Gamst AC, Archibald SL, Fennema-Notestine C, Mindt MR, Marcotte TD, Heaton RK, Ellis RJ, Grant I (2005) Effects of methamphetamine dependence and HIV infection on cerebral morphology. Am J Psychiatry 162:1461–1472PubMedCrossRef
Zurück zum Zitat Jernigan TL, Archibald SL, Fennema-Notestine C, Taylor MJ, Theilmann RJ, Julaton MD, Notestine RJ, Wolfson T, Letendre SL, Ellis RJ, Heaton RK, Gamst AC, Franklin DR Jr, Clifford DB, Collier AC, Gelman BB, Marra C, McArthur JC, McCutchan JA, Morgello S, Simpson DM, Grant I (2011) CHARTER Group: clinical factors related to brain structure in HIV: The CHARTER Study. J Neurovirol 17:248–257PubMedCentralPubMedCrossRef Jernigan TL, Archibald SL, Fennema-Notestine C, Taylor MJ, Theilmann RJ, Julaton MD, Notestine RJ, Wolfson T, Letendre SL, Ellis RJ, Heaton RK, Gamst AC, Franklin DR Jr, Clifford DB, Collier AC, Gelman BB, Marra C, McArthur JC, McCutchan JA, Morgello S, Simpson DM, Grant I (2011) CHARTER Group: clinical factors related to brain structure in HIV: The CHARTER Study. J Neurovirol 17:248–257PubMedCentralPubMedCrossRef
Zurück zum Zitat Keltner JR, Vaida F, Ellis RJ, Moeller-Bertram T, Fitzsimmons C, Duarte NA, Robinson-Papp J, Dworkin RH, Clifford DB, McArthur JC, Simpson DM, Collier AC, Marra CM, Atkinson JH, Grant I; CHARTER Group (2012) Health-related quality of life ‘well-being’ in HIV distal neuropathic pain is more strongly associated with depression severity than with pain intensity. Psychosomatics 53(4):380–386PubMedCentralPubMedCrossRef Keltner JR, Vaida F, Ellis RJ, Moeller-Bertram T, Fitzsimmons C, Duarte NA, Robinson-Papp J, Dworkin RH, Clifford DB, McArthur JC, Simpson DM, Collier AC, Marra CM, Atkinson JH, Grant I; CHARTER Group (2012) Health-related quality of life ‘well-being’ in HIV distal neuropathic pain is more strongly associated with depression severity than with pain intensity. Psychosomatics 53(4):380–386PubMedCentralPubMedCrossRef
Zurück zum Zitat Lee MC, Tracey I (2010) Unravelling the mystery of pain, suffering, and relief with brain imaging. Curr Pain Headache Rep 14:124–131PubMedCrossRef Lee MC, Tracey I (2010) Unravelling the mystery of pain, suffering, and relief with brain imaging. Curr Pain Headache Rep 14:124–131PubMedCrossRef
Zurück zum Zitat Lin K, Taylor MJ, Heaton R, Franklin D, Jernigan T, Fennema-Notestine C, McCutchan A, Atkinson JH, Ellis RJ, McArthur J, Morgello S, Simpson D, Collier AC, Marra C, Gelman B, Clifford D, Grant I (2011) CHARTER group: effects of traumatic brain injury on cognitive functioning and cerebral metabolites in HIV-infected individuals. J Clin Exp Neuropsychol 33:326–334PubMedCentralPubMedCrossRef Lin K, Taylor MJ, Heaton R, Franklin D, Jernigan T, Fennema-Notestine C, McCutchan A, Atkinson JH, Ellis RJ, McArthur J, Morgello S, Simpson D, Collier AC, Marra C, Gelman B, Clifford D, Grant I (2011) CHARTER group: effects of traumatic brain injury on cognitive functioning and cerebral metabolites in HIV-infected individuals. J Clin Exp Neuropsychol 33:326–334PubMedCentralPubMedCrossRef
Zurück zum Zitat Lipps GE, Lowe GA, De La Haye W, Longman-Mills S, Clarke TR, Barton EN, Bain B (2010) Validation of the Beck Depression Inventory II in HIV-positive patients. West Indian Med J 59:374PubMed Lipps GE, Lowe GA, De La Haye W, Longman-Mills S, Clarke TR, Barton EN, Bain B (2010) Validation of the Beck Depression Inventory II in HIV-positive patients. West Indian Med J 59:374PubMed
Zurück zum Zitat Lucey BP, Clifford DB, Creighton J, Edwards RR, McArthur JC, Haythornthwaite J (2011) Relationship of depression and catastrophizing to pain, disability, and medication adherence in patients with HIV-associated sensory neuropathy. AIDS Care 23(8):921–928PubMedCrossRef Lucey BP, Clifford DB, Creighton J, Edwards RR, McArthur JC, Haythornthwaite J (2011) Relationship of depression and catastrophizing to pain, disability, and medication adherence in patients with HIV-associated sensory neuropathy. AIDS Care 23(8):921–928PubMedCrossRef
Zurück zum Zitat May A (2009) Morphing voxels: the hype around structural imaging of headache patients. Brain 132:1419–1425PubMedCrossRef May A (2009) Morphing voxels: the hype around structural imaging of headache patients. Brain 132:1419–1425PubMedCrossRef
Zurück zum Zitat May A (2011) Structural brain imaging: a window into chronic pain. Neuroscientist 17(2):209–220PubMedCrossRef May A (2011) Structural brain imaging: a window into chronic pain. Neuroscientist 17(2):209–220PubMedCrossRef
Zurück zum Zitat Paul R, Cohen R, Navia B, Tashima K (2002) Relationships between cognition and structural neuroimaging findings in adults with human immunodeficiency virus type-1. Neurosci Biobehav Rev 26:353–359PubMedCrossRef Paul R, Cohen R, Navia B, Tashima K (2002) Relationships between cognition and structural neuroimaging findings in adults with human immunodeficiency virus type-1. Neurosci Biobehav Rev 26:353–359PubMedCrossRef
Zurück zum Zitat Robinson-Papp J, Morgello S, Vaida F, Fitzsimons C, Simpson DM, Elliott KJ, Al-Lozi M, Gelman BB, Clifford D, Marra CM, McCutchan JA, Atkinson JH, Dworkin RH, Grant I, Ellis R (2010) Association of self-reported painful symptoms with clinical and neurophysiologic signs in HIV-associated sensory neuropathy. Pain 151:732–736PubMedCentralPubMedCrossRef Robinson-Papp J, Morgello S, Vaida F, Fitzsimons C, Simpson DM, Elliott KJ, Al-Lozi M, Gelman BB, Clifford D, Marra CM, McCutchan JA, Atkinson JH, Dworkin RH, Grant I, Ellis R (2010) Association of self-reported painful symptoms with clinical and neurophysiologic signs in HIV-associated sensory neuropathy. Pain 151:732–736PubMedCentralPubMedCrossRef
Zurück zum Zitat Rodriguez-Raecke R, Niemeier A, Ihle K, Ruether W, May A (2009) Brain gray matter decrease in chronic pain is the consequence and not the cause of pain. J Neurosci 29:13746–13750PubMedCrossRef Rodriguez-Raecke R, Niemeier A, Ihle K, Ruether W, May A (2009) Brain gray matter decrease in chronic pain is the consequence and not the cause of pain. J Neurosci 29:13746–13750PubMedCrossRef
Zurück zum Zitat Schmitz N, Admiraal-Behloul F, Arkink EB, Kruit MC, Schoonman GG, Ferrari MD, van Buchem MA (2008) Attack frequency and disease duration as indicators for brain damage in migraine. Headache 48:1044–1055PubMedCrossRef Schmitz N, Admiraal-Behloul F, Arkink EB, Kruit MC, Schoonman GG, Ferrari MD, van Buchem MA (2008) Attack frequency and disease duration as indicators for brain damage in migraine. Headache 48:1044–1055PubMedCrossRef
Zurück zum Zitat Seminowicz DA, Wideman TH, Naso L, Hatami-Khoroushahi Z, Fallatah S, Ware MA, Jarzem P, Bushnell MC, Shir Y, Ouellet JA, Stone LS (2011) Effective treatment of chronic low back pain in humans reverses abnormal brain anatomy and function. J Neurosci 31:7540–7550PubMedCrossRef Seminowicz DA, Wideman TH, Naso L, Hatami-Khoroushahi Z, Fallatah S, Ware MA, Jarzem P, Bushnell MC, Shir Y, Ouellet JA, Stone LS (2011) Effective treatment of chronic low back pain in humans reverses abnormal brain anatomy and function. J Neurosci 31:7540–7550PubMedCrossRef
Zurück zum Zitat Simpson DM, Kitch D, Evans SR, McArthur JC, Asmuth DM, Cohen B, Goodkin K, Gerschenson M, Marra CM, Diaz-Arrastia R, Shriver S, Milllar L, Clifford DB (2006) ACTG A5117 Study Group: HIV neuropathy natural history cohort study: assessment measures and risk factors. Neurology 66:1679–1687PubMedCrossRef Simpson DM, Kitch D, Evans SR, McArthur JC, Asmuth DM, Cohen B, Goodkin K, Gerschenson M, Marra CM, Diaz-Arrastia R, Shriver S, Milllar L, Clifford DB (2006) ACTG A5117 Study Group: HIV neuropathy natural history cohort study: assessment measures and risk factors. Neurology 66:1679–1687PubMedCrossRef
Zurück zum Zitat Simpson DM, Brown S, Tobias J (2008) Controlled trial of high-concentration capsaicin patch for treatment of painful HIV neuropathy. Neurology 70:2305–2313PubMedCrossRef Simpson DM, Brown S, Tobias J (2008) Controlled trial of high-concentration capsaicin patch for treatment of painful HIV neuropathy. Neurology 70:2305–2313PubMedCrossRef
Zurück zum Zitat Skopelitis E, Aroni K, Kontos AN, Konstantinou K, Kokotis P, Karandreas N, Kordossis T (2007) Early detection of subclinical HIV sensory polyneuropathy using intraepidermal nerve fibre density quantification: association with HIV stage and surrogate markers. Int J STD AIDS 7:856–860CrossRef Skopelitis E, Aroni K, Kontos AN, Konstantinou K, Kokotis P, Karandreas N, Kordossis T (2007) Early detection of subclinical HIV sensory polyneuropathy using intraepidermal nerve fibre density quantification: association with HIV stage and surrogate markers. Int J STD AIDS 7:856–860CrossRef
Zurück zum Zitat Smallwood RF, Laird AR, Ramage AE, Parkinson AL, Lewis J, Clauw DJ, Williams DA, Schmidt-Wilcke T, Farrell MJ, Eickhoff SB, Robin DA (2013) Structural brain anomalies and chronic pain: a quantitative meta-analysis of gray matter volume. J Pain 14:663–675PubMedCrossRef Smallwood RF, Laird AR, Ramage AE, Parkinson AL, Lewis J, Clauw DJ, Williams DA, Schmidt-Wilcke T, Farrell MJ, Eickhoff SB, Robin DA (2013) Structural brain anomalies and chronic pain: a quantitative meta-analysis of gray matter volume. J Pain 14:663–675PubMedCrossRef
Zurück zum Zitat Smola AJ, Schölkopf B (2004) A tutorial on support vector regression. Stat Comput 14(3):199–222CrossRef Smola AJ, Schölkopf B (2004) A tutorial on support vector regression. Stat Comput 14(3):199–222CrossRef
Zurück zum Zitat Truong W, Minuzzi L, Soares CN, Frey BN, Evans AC, MacQueen GM, Hall GBC (2013) Changes in cortical thickness across the lifespan in major depressive disorder. Psychiatry Res Neuroimaging 214:204–211CrossRef Truong W, Minuzzi L, Soares CN, Frey BN, Evans AC, MacQueen GM, Hall GBC (2013) Changes in cortical thickness across the lifespan in major depressive disorder. Psychiatry Res Neuroimaging 214:204–211CrossRef
Zurück zum Zitat Verma S, Estanislao L, Mintz L, Simpson D (2004) Controlling neuropathic pain in HIV. Curr Infect Dis Rep 6:237–242PubMedCrossRef Verma S, Estanislao L, Mintz L, Simpson D (2004) Controlling neuropathic pain in HIV. Curr Infect Dis Rep 6:237–242PubMedCrossRef
Zurück zum Zitat Wiebe LA, Phillips TJ, Li JM, Allen JA, Shetty K (2011) Pain in HIV: an evolving epidemic. J Pain 12:619–624PubMedCrossRef Wiebe LA, Phillips TJ, Li JM, Allen JA, Shetty K (2011) Pain in HIV: an evolving epidemic. J Pain 12:619–624PubMedCrossRef
Zurück zum Zitat Wittchen HU, Robins LN, Cottler LB, Sartorius N, Burke JD, Regier D (1991) Cross-cultural feasibility, reliability and sources of variance of the Composite International Diagnostic Interview (CIDI). Br J Psychiatry 159:645–653PubMedCrossRef Wittchen HU, Robins LN, Cottler LB, Sartorius N, Burke JD, Regier D (1991) Cross-cultural feasibility, reliability and sources of variance of the Composite International Diagnostic Interview (CIDI). Br J Psychiatry 159:645–653PubMedCrossRef
Metadaten
Titel
HIV-associated distal neuropathic pain is associated with smaller total cerebral cortical gray matter
verfasst von
John R. Keltner
Christine Fennema-Notestine
Florin Vaida
Dongzhe Wang
Donald R. Franklin
Robert H. Dworkin
Chelsea Sanders
J. Allen McCutchan
Sarah L. Archibald
David J. Miller
George Kesidis
Clint Cushman
Sung Min Kim
Ian Abramson
Michael J. Taylor
Rebecca J. Theilmann
Michelle D. Julaton
Randy J. Notestine
Stephanie Corkran
Mariana Cherner
Nichole A. Duarte
Terry Alexander
Jessica Robinson-Papp
Benjamin B. Gelman
David M. Simpson
Ann C. Collier
Christina M. Marra
Susan Morgello
Greg Brown
Igor Grant
J. Hampton Atkinson
Terry L. Jernigan
Ronald J. Ellis
for the CHARTER Group
Publikationsdatum
01.06.2014
Verlag
Springer US
Erschienen in
Journal of NeuroVirology / Ausgabe 3/2014
Print ISSN: 1355-0284
Elektronische ISSN: 1538-2443
DOI
https://doi.org/10.1007/s13365-014-0236-8

Weitere Artikel der Ausgabe 3/2014

Journal of NeuroVirology 3/2014 Zur Ausgabe

Leitlinien kompakt für die Neurologie

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Neu im Fachgebiet Neurologie

Update Neurologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.