You have to go back, way back – over twenty years – to find Dr. Nancy Klimas’s first contribution to ME/CFS research. With a nice career in HIV research underway, Dr. Klimas – in a move that must have left some of her colleagues shaking their heads- took a chance on a controversial disease early in their career.

Dr. Klimas and her research partner, Dr. Mary Fletcher have played significant roles in uncovering the immune abnormalities, particularly natural killer cell dysfunction, present in this disorder. Their first paper on natural killer cell dysfunction appeared in 1990. Now believed to be major player in ME/CFS pathophysiology, the Fletcher/Klimas research has spurred researchers from across the US, including the CDC, and now Australia to tackle natural killer cell research. and has continued on and off for over 20 years.

A 2005 Klimas/Fletcher study indicated reduced perforin may be the culprit in the low NK cell problems. A 2006 paper suggested that the first verified subset in ME/CFS could very well end up being poor NK cell functioning. The Klimas/Fletcher team was the first to find an explicit connection between two key parts of the CFS puzzle – the immune system and the sympathetic nervous system – with their natural killer cell and neuropeptide Y findings.

An eager collaborator, Dr. Klimas has worked with many researchers including the CDC on the Pharmacogenomics project, with Dr. Broderick in 2010,  with the Lipkin XMRV studies and the Australian PHANU team in 2011. Most recently Dr Klimas was a co-author of the International Consensus Criteria for ME.  The Klimas/Broderick/Fletcher embrace a systems biology approach to ME/CFS is uncovering evidence of systemic dysregulation in how the immune and neuroendocrine systems communicate in ME/CFS.

In between her research and her work as a physician, Dr. Klimas has forged a career of public service in CFS that may be unmatched. Twice President of our professional organization for CFS under Dr Klimas direction the organization changed its name from AACFS to IACFS/ME and took on a more international outlook. Dr. Klimas then served a term on the federal advisory committee for CFS (CFSAC). She is a co-author of both the Canadian Consensus Criteria and the International Consensus Criteria on ME.

A longtime physician specializing in ME/CFS, HIV and GWI, Dr. Klimas received the Nelson Gantz Clinician award at the 2011 IACFS/ME Conference (Dr. Fletcher received the Research Excellence Award). Dr. Klimas endeared herself to CFS patients around the world and, no doubt, caused a collective gasp in the traditional medical community, when she boldly stated in the New York Times.

My H.I.V. patients for the most part are hale and hearty thanks to three decades of intense and excellent research and billions of dollars invested. Many of my C.F.S. patients, on the other hand, are terribly ill and unable to work or participate in the care of their families.I split my clinical time between the two illnesses, and I can tell you if I had to choose between the two illnesses (in 2009) I would rather have H.I.V.

Dr. Klimas stopped her work on HIV on 2012 and now focuses solely on ME/CFS and GWI.  In 2011 she left the University of Miami to become Scientific Director of the newly created Institute for Neuroimmune Research at Nova Southeastern in Fort Lauderdale, Florida.

To See Dr. Klimas as a Patient

8720 N. Kendall Drive,
Suite 108,
Miami FL 33176

University Park Plaza
3424 South University Drive
Suite 3440
Fort Lauderdale, FL 33328

(954) NSU-CARE (678-2273).

Mon-Fri 8:00am-5:00pm
Saturday 8:00am-2:00pm

Institute For Neuroimmune Research at Nova Southeastern

• Website 
• Video’s From the Jan 2013 Patient Conference
• Video of Dr. Klimas talking about the Institute
• Donate to the Institute

Articles and Blogs

• Quick Hits from Dr. Klimas Neuroimmune Institute opening:  Tweeting the Conference (Jan 2012) 
• Dr. Klimas on Deconditioning, Exercise, Inflammation and Recovery (Jan 2012)
• An ME/CFS Celebration: Dr. Klimas coming out party at Nova Southeastern (Jan 2012) 
• Cort Johnson speaks with Dr. Klimas  on the new Institute for Neuro-immune Medicine (Dec 2011)
• Dr. Nancy Klimas forms Neuro-Immune Institute on ME/CFS at Nova Southeastern University (Dec 2011)
• Safe Exercise? The heart rate based video series at ME/CFS Community Center
• Cort Johnson speaks with Dr. Klimas on her new clinic,  her treatment protocols, XMRV and pathogens (Jan 2010)
• Feature story on Dr. Klimas and Dr. Fletcher at the University of Miami (2007)

Actvities

•  Director of one of three NIH CFS Research Centers (@1998-2001)
• Professor of Medicine, Psychology, Microbiology and Immunology at the University of Miami, Miller School of Medicine, Clinician at the University of Miami Miller School of Medicine (1984-2011)
• Director of Clinical Immunology Research at the Miami VAMC.
• President of the International Association of Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (IACFS/ME)
• Co-author of the Canadian Consensus Criteria
• Collaborator in the Pharmacogenomics Project at the CDC
• Co-author of the International Consensus Criteria for ME
• Federal Advisory Committee Member (CFSAC)
•  Winner of 2011 Nelson Gantz Clinician award
• Scientific Director of the Institute for Neuro-Immune Medicine, Nova Southeastern University

 

Publications

1: Broderick G, Ben-Hamo R, Vashishtha S, Efroni S, Nathanson L, Barnes Z,
Fletcher MA, Klimas N. Altered immune pathway activity under exercise challenge
in Gulf War Illness: An exploratory analysis. Brain Behav Immun. 2013
Feb;28:159-69. doi: 10.1016/j.bbi.2012.11.007. Epub 2012 Nov 29. PubMed PMID:
23201588.

2: Alter HJ, Mikovits JA, Switzer WM, Ruscetti FW, Lo SC, Klimas N, Komaroff AL,
Montoya JG, Bateman L, Levine S, Peterson D, Levin B, Hanson MR, Genfi A, Bhat M,
Zheng H, Wang R, Li B, Hung GC, Lee LL, Sameroff S, Heneine W, Coffin J, Hornig
M, Lipkin WI. A multicenter blinded analysis indicates no association between
chronic fatigue syndrome/myalgic encephalomyelitis and either xenotropic murine
leukemia virus-related virus or polytropic murine leukemia virus. MBio. 2012 Sep
18;3(5). doi:pii: e00266-12. 10.1128/mBio.00266-12. Print 2012. PubMed PMID:
22991430; PubMed Central PMCID: PMC3448165.

3: Broderick G, Katz BZ, Fernandes H, Fletcher MA, Klimas N, Smith FA, O’Gorman
MR, Vernon SD, Taylor R. Cytokine expression profiles of immune imbalance in
post-mononucleosis chronic fatigue. J Transl Med. 2012 Sep 13;10:191. doi:
10.1186/1479-5876-10-191. PubMed PMID: 22973830; PubMed Central PMCID:
PMC3480896.

4: Fletcher MA, Barnes Z, Broderick G, Klimas NG. Psychoneuroimmunology and
natural killer cells: the chromium release whole blood assay. Methods Mol Biol.
2012;934:313-24. doi: 10.1007/978-1-62703-071-7_16. PubMed PMID: 22933153.

5: Broderick G, Fletcher MA, Gallagher M, Barnes Z, Vernon SD, Klimas NG.
Exploring the diagnostic potential of immune biomarker coexpression in Gulf War
Illness. Methods Mol Biol. 2012;934:145-64. doi: 10.1007/978-1-62703-071-7_8.
PubMed PMID: 22933145.

6: Klimas NG, Broderick G, Fletcher MA. Biomarkers for chronic fatigue. Brain
Behav Immun. 2012 Nov;26(8):1202-10. doi: 10.1016/j.bbi.2012.06.006. Epub 2012
Jun 23. PubMed PMID: 22732129.

7: Lattie EG, Antoni MH, Fletcher MA, Penedo F, Czaja S, Lopez C, Perdomo D, Sala
A, Nair S, Fu SH, Klimas N. Stress management skills, neuroimmune processes and
fatigue levels in persons with chronic fatigue syndrome. Brain Behav Immun. 2012
Aug;26(6):849-58. doi: 10.1016/j.bbi.2012.02.008. Epub 2012 Mar 6. PubMed PMID:
22417946.

8: Jason LA, Unger ER, Dimitrakoff JD, Fagin AP, Houghton M, Cook DB, Marshall GD
Jr, Klimas N, Snell C. Minimum data elements for research reports on CFS. Brain
Behav Immun. 2012 Mar;26(3):401-6. doi: 10.1016/j.bbi.2012.01.014. Epub 2012 Jan
28. PubMed PMID: 22306456.

9: Ginzburg E, Klimas N, Parvus C, Life J, Willix R, Barber MJ, Lin A, Comite F.
Long-term Safety of Testosterone and Growth Hormone Supplementation: A
Retrospective Study of Metabolic, Cardiovascular, and Oncologic Outcomes. J Clin
Med Res. 2010 Aug 18;2(4):159-66. doi: 10.4021/jocmr428w. PubMed PMID: 21629532;
PubMed Central PMCID: PMC3104655.

10: Brenu EW, van Driel ML, Staines DR, Ashton KJ, Ramos SB, Keane J, Klimas NG,
Marshall-Gradisnik SM. Immunological abnormalities as potential biomarkers in
Chronic Fatigue Syndrome/Myalgic Encephalomyelitis. J Transl Med. 2011 May
28;9:81. doi: 10.1186/1479-5876-9-81. PubMed PMID: 21619669; PubMed Central
PMCID: PMC3120691.

11: Holodniy M, Brown ST, Cameron DW, Kyriakides TC, Angus B, Babiker A, Singer
J, Owens DK, Anis A, Goodall R, Hudson F, Piaseczny M, Russo J, Schechter M,
Deyton L, Darbyshire J; OPTIMA Team. Results of antiretroviral treatment
interruption and intensification in advanced multi-drug resistant HIV infection
from the OPTIMA trial. PLoS One. 2011 Mar 31;6(3):e14764. doi:
10.1371/journal.pone.0014764. PubMed PMID: 21483491; PubMed Central PMCID:
PMC3069000.

12: Lopez C, Antoni M, Penedo F, Weiss D, Cruess S, Segotas MC, Helder L, Siegel
S, Klimas N, Fletcher MA. A pilot study of cognitive behavioral stress management
effects on stress, quality of life, and symptoms in persons with chronic fatigue
syndrome. J Psychosom Res. 2011 Apr;70(4):328-34. doi:10.1016/j.jpsychores.2010.11.010. Epub 2011 Jan 15. PubMed PMID: 21414452; PubMed
Central PMCID: PMC3073706.

13: Fekete EM, Antoni MH, Lopez C, Mendez AJ, Szeto A, Fletcher MA, Klimas N,
Kumar M, Schneiderman N. Stress buffering effects of oxytocin on HIV status in
low-income ethnic minority women. Psychoneuroendocrinology. 2011
Jul;36(6):881-90. doi: 10.1016/j.psyneuen.2010.12.003. Epub 2011 Jan 6. PubMed
PMID: 21215526; PubMed Central PMCID: PMC3094741.

14: Fletcher MA, Rosenthal M, Antoni M, Ironson G, Zeng XR, Barnes Z, Harvey JM,
Hurwitz B, Levis S, Broderick G, Klimas NG. Plasma neuropeptide Y: a biomarker
for symptom severity in chronic fatigue syndrome. Behav Brain Funct. 2010 Dec
29;6:76. doi: 10.1186/1744-9081-6-76. PubMed PMID: 21190576; PubMed Central
PMCID: PMC3024290.

15: Broderick G, Kreitz A, Fuite J, Fletcher MA, Vernon SD, Klimas N. A pilot
study of immune network remodeling under challenge in Gulf War Illness. Brain
Behav Immun. 2011 Feb;25(2):302-13. doi: 10.1016/j.bbi.2010.10.011. Epub 2010 Oct
16. PubMed PMID: 20955779.

16: Pett SL, Carey C, Lin E, Wentworth D, Lazovski J, Miró JM, Gordin F, Angus B,
Rodriguez-Barradas M, Rubio R, Tambussi G, Cooper DA, Emery S; INSIGHT-ESPRIT
Study Group. Predictors of bacterial pneumonia in Evaluation of Subcutaneous
Interleukin-2 in a Randomized International Trial (ESPRIT). HIV Med. 2011
Apr;12(4):219-27. doi: 10.1111/j.1468-1293.2010.00875.x. Epub 2010 Aug 31. PubMed
PMID: 20812949; PubMed Central PMCID: PMC3048911.

17: Fletcher MA, Zeng XR, Maher K, Levis S, Hurwitz B, Antoni M, Broderick G,
Klimas NG. Biomarkers in chronic fatigue syndrome: evaluation of natural killer
cell function and dipeptidyl peptidase IV/CD26. PLoS One. 2010 May
25;5(5):e10817. doi: 10.1371/journal.pone.0010817. PubMed PMID: 20520837; PubMed
Central PMCID: PMC2876037.

18: Broderick G, Fuite J, Kreitz A, Vernon SD, Klimas N, Fletcher MA. A formal
analysis of cytokine networks in chronic fatigue syndrome. Brain Behav Immun.
2010 Oct;24(7):1209-17. doi: 10.1016/j.bbi.2010.04.012. Epub 2010 May 4. PubMed
PMID: 20447453; PubMed Central PMCID: PMC2939140.

19: Fletcher MA, Zeng XR, Barnes Z, Levis S, Klimas NG. Plasma cytokines in women
with chronic fatigue syndrome. J Transl Med. 2009 Nov 12;7:96. doi:
10.1186/1479-5876-7-96. PubMed PMID: 19909538; PubMed Central PMCID: PMC2779802.

20: Fekete EM, Antoni MH, Lopez CR, Durán RE, Penedo FJ, Bandiera FC, Fletcher
MA, Klimas N, Kumar M, Schneiderman N. Men’s serostatus disclosure to parents:
associations among social support, ethnicity, and disease status in men living
with HIV. Brain Behav Immun. 2009 Jul;23(5):693-9. doi:10.1016/j.bbi.2009.01.007. Epub 2009 Jan 21. PubMed PMID: 19486655; PubMedCentral PMCID: PMC2724722.

21: Hurwitz BE, Coryell VT, Parker M, Martin P, Laperriere A, Klimas NG,
Sfakianakis GN, Bilsker MS. Chronic fatigue syndrome: illness severity, sedentary
lifestyle, blood volume and evidence of diminished cardiac function. Clin Sci
(Lond). 2009 Oct 19;118(2):125-35. doi: 10.1042/CS20090055. PubMed PMID:
19469714.

22: Whistler T, Fletcher MA, Lonergan W, Zeng XR, Lin JM, Laperriere A, Vernon
SD, Klimas NG. Impaired immune function in Gulf War Illness. BMC Med Genomics.
2009 Mar 5;2:12. doi: 10.1186/1755-8794-2-12. PubMed PMID: 19265525; PubMed
Central PMCID: PMC2657162.

23: Burman W, Grund B, Neuhaus J, Douglas J Jr, Friedland G, Telzak E,
Colebunders R, Paton N, Fisher M, Rietmeijer C; SMART Study Group and INSIGHT.
Episodic antiretroviral therapy increases HIV transmission risk compared with
continuous therapy: results of a randomized controlled trial. J Acquir Immune
Defic Syndr. 2008 Oct 1;49(2):142-50. doi: 10.1097/QAI.0b013e318183a9ad. PubMed
PMID: 18769356; PubMed Central PMCID: PMC2749067.

24: Klimas N, Koneru AO, Fletcher MA. Overview of HIV. Psychosom Med. 2008
Jun;70(5):523-30. doi: 10.1097/PSY.0b013e31817ae69f. Review. PubMed PMID:
18541903.

25: Greeson JM, Hurwitz BE, Llabre MM, Schneiderman N, Penedo FJ, Klimas NG.
Psychological distress, killer lymphocytes and disease severity in HIV/AIDS.
Brain Behav Immun. 2008 Aug;22(6):901-11. doi: 10.1016/j.bbi.2008.01.001. Epub
2008 Mar 5. PubMed PMID: 18321678.

26: Klimas NG, Koneru AO. Chronic fatigue syndrome: inflammation, immune
function, and neuroendocrine interactions. Curr Rheumatol Rep. 2007
Dec;9(6):482-7. Review. PubMed PMID: 18177602.

27: Ginzburg E, Lin A, Sigler M, Olsen D, Klimas N, Mintz A. Testosterone and
growth hormone normalization: a retrospective study of health outcomes. J
Multidiscip Healthc. 2008 Sep 1;1:79-86. PubMed PMID: 21197337; PubMed Central
PMCID: PMC3004552.

28: Jones JF, Kohl KS, Ahmadipour N, Bleijenberg G, Buchwald D, Evengard B, Jason
LA, Klimas NG, Lloyd A, McCleary K, Oleske JM, White PD; Brighton Collaboration
Fatigue Working Group. Fatigue: case definition and guidelines for collection,
analysis, and presentation of immunization safety data. Vaccine. 2007 Aug
1;25(31):5685-96. Epub 2007 Mar 12. PubMed PMID: 17400340.

29: ESPRIT Research Group, Fox Z, Antunes F, Davey R, Gazzard B, Klimas N,
Labriola A, Losso M, Neaton JD, Phillips AN, Ruxrungtham K, Staszewski S, Weiss
L, Lundgren JD. Predictors of CD4 count change over 8 months of follow up in
HIV-1-infected patients with a CD4 count>or=300 cells/microL who were assigned to
7.5 MIU interleukin-2. HIV Med. 2007 Mar;8(2):112-23. PubMed PMID: 17352768.

30: Eisen SA, Karlinsky J, Jackson LW, Blanchard M, Kang HK, Murphy FM, Alpern R,
Reda DJ, Toomey R, Battistone MJ, Parks BJ, Klimas N, Pak HS, Hunter J, Lyons MJ,
Henderson WG; Gulf War Study Partcipating Investigators. Spouses of Persian Gulf
War I veterans: medical evaluation of a U.S. cohort. Mil Med. 2006
Jul;171(7):613-8. PubMed PMID: 16895127.

31: Dixon D, Cruess S, Kilbourn K, Klimas N, Fletcher MA, Ironson G, Baum A,
Schneiderman N, Antoni MH. Social Support Mediates Loneliness and Human
Herpesvirus Type 6 (HHV-6) Antibody Titers. J Appl Soc Psychol. 2006 Jul
31;31(6):1111-1132. PubMed PMID: 20407593; PubMed Central PMCID: PMC2855978.

32: Siegel SD, Antoni MH, Fletcher MA, Maher K, Segota MC, Klimas N. Impaired
natural immunity, cognitive dysfunction, and physical symptoms in patients with
chronic fatigue syndrome: preliminary evidence for a subgroup? J Psychosom Res.
2006 Jun;60(6):559-66. PubMed PMID: 16731230.

33: Craddock RC, Taylor R, Broderick G, Whistler T, Klimas N, Unger ER.
Exploration of statistical dependence between illness parameters using the
entropy correlation coefficient. Pharmacogenomics. 2006 Apr;7(3):421-8. PubMedPMID: 16610952.

34: Broderick G, Craddock RC, Whistler T, Taylor R, Klimas N, Unger ER.
Identifying illness parameters in fatiguing syndromes using classical projection
methods. Pharmacogenomics. 2006 Apr;7(3):407-19. PubMed PMID: 16610951.
35: Whistler T, Taylor R, Craddock RC, Broderick G, Klimas N, Unger ER. Gene
expression correlates of unexplained fatigue. Pharmacogenomics. 2006
Apr;7(3):395-405. PubMed PMID: 16610950.

36: Carrico AW, Antoni MH, Duran RE, Ironson G, Penedo F, Fletcher MA, Klimas N,
Schneiderman N. Reductions in depressed mood and denial coping during cognitive
behavioral stress management with HIV-Positive gay men treated with HAART. Ann
Behav Med. 2006 Apr;31(2):155-64. PubMed PMID: 16542130.

37: Antoni MH, Carrico AW, Durán RE, Spitzer S, Penedo F, Ironson G, Fletcher MA,
Klimas N, Schneiderman N. Randomized clinical trial of cognitive behavioral
stress management on human immunodeficiency virus viral load in gay men treated
with highly active antiretroviral therapy. Psychosom Med. 2006
Jan-Feb;68(1):143-51. PubMed PMID: 16449425.

38: Ironson G, O’Cleirigh C, Fletcher MA, Laurenceau JP, Balbin E, Klimas N,
Schneiderman N, Solomon G. Psychosocial factors predict CD4 and viral load change
in men and women with human immunodeficiency virus in the era of highly active
antiretroviral treatment. Psychosom Med. 2005 Nov-Dec;67(6):1013-21. PubMed PMID:
16314608; PubMed Central PMCID: PMC2614887.

39: Carrico AW, Antoni MH, Pereira DB, Fletcher MA, Klimas N, Lechner SC,
Schneiderman N. Cognitive behavioral stress management effects on mood, social
support, and a marker of antiviral immunity are maintained up to 1 year in
HIV-infected gay men. Int J Behav Med. 2005;12(4):218-26. PubMed PMID: 16262540.

40: Hurwitz BE, Brownley KA, Motivala SJ, Milanovich JR, Kibler JL, Fillion L,
LeBlanc WG, Kumar M, Klimas NG, Fletcher MA, Schneiderman N. Sympathoimmune
anomalies underlying the response to stressful challenge in human
immunodeficiency virus spectrum disease. Psychosom Med. 2005
Sep-Oct;67(5):798-806. PubMed PMID: 16204441.

41: Eisen SA, Kang HK, Murphy FM, Blanchard MS, Reda DJ, Henderson WG, Toomey R,
Jackson LW, Alpern R, Parks BJ, Klimas N, Hall C, Pak HS, Hunter J, Karlinsky J,
Battistone MJ, Lyons MJ; Gulf War Study Participating Investigators. Gulf War
veterans’ health: medical evaluation of a U.S. cohort. Ann Intern Med. 2005 Jun
7;142(11):881-90. PubMed PMID: 15941694.

42: Antoni MH, Cruess DG, Klimas N, Carrico AW, Maher K, Cruess S, Lechner SC,
Kumar M, Lutgendorf S, Ironson G, Fletcher MA, Schneiderman N. Increases in a
marker of immune system reconstitution are predated by decreases in 24-h urinary
cortisol output and depressed mood during a 10-week stress management
intervention in symptomatic HIV-infected men. J Psychosom Res. 2005
Jan;58(1):3-13. PubMed PMID: 15771864.

43: Glaser R, Padgett DA, Litsky ML, Baiocchi RA, Yang EV, Chen M, Yeh PE, Klimas
NG, Marshall GD, Whiteside T, Herberman R, Kiecolt-Glaser J, Williams MV.
Stress-associated changes in the steady-state expression of latent Epstein-Barr
virus: implications for chronic fatigue syndrome and cancer. Brain Behav Immun.
2005 Mar;19(2):91-103. PubMed PMID: 15664781.

44: McPherson-Baker S, Jones D, Durán RE, Klimas N, Schneiderman N. Development
and implementation of a medication adherence training instrument for persons
living with HIV: the MATI. Behav Modif. 2005 Mar;29(2):286-317. PubMed PMID:
15657412.

45: Hurwitz BE, Klimas NG, Llabre MM, Maher KJ, Skyler JS, Bilsker MS,
McPherson-Baker S, Lawrence PJ, Laperriere AR, Greeson JM, Klaus JR, Lawrence R,
Schneiderman N. HIV, metabolic syndrome X, inflammation, oxidative stress, and
coronary heart disease risk : role of protease inhibitor exposure. Cardiovasc
Toxicol. 2004;4(3):303-16. PubMed PMID: 15470277.

46: Gonzalez JS, Penedo FJ, Antoni MH, Durán RE, McPherson-Baker S, Ironson G,
Isabel Fernandez M, Klimas NG, Fletcher MA, Schneiderman N. Social support,
positive states of mind, and HIV treatment adherence in men and women living with
HIV/AIDS. Health Psychol. 2004 Jul;23(4):413-8. PubMed PMID: 15264978.

47: Reeves WC, Lloyd A, Vernon SD, Klimas N, Jason LA, Bleijenberg G, Evengard B,
White PD, Nisenbaum R, Unger ER; International Chronic Fatigue Syndrome Study
Group. Identification of ambiguities in the 1994 chronic fatigue syndrome
research case definition and recommendations for resolution. BMC Health Serv Res.
2003 Dec 31;3(1):25. Review. PubMed PMID: 14702202; PubMed Central PMCID:
PMC317472.

48: Patarca R, Isava A, Campo R, Rodriguez NJ, Nunez E, Alter M, Marchette M,
Sanabia MM, Mitchell C, Rivera D, Scott G, Jayaweera D, Moreno J, Boulanger C,
Kolber M, Mask CW, Sierra EM, Vallejo R, Page JB, Klimas NG, Fletcher M. Human
immunodeficiency virus type 1 pharmacogenomics in clinical practice: relevance of
HIV-1 drug resistance testing (Part 2). J Environ Pathol Toxicol Oncol.
2003;22(4):235-79. Review. PubMed PMID: 14669906.

49: Patarca R, Isava A, Campo R, Rodriguez NJ, Nunez E, Alter M, Marchette M,
Sanabia MM, Mitchell C, Rivera D, Scott G, Jayaweera D, Moreno J, Boulanger C,
Kolber M, Mask CW, Sierra EM, Vallejo R, Page JB, Klimas NG, Fletcher MA. Human
immunodeficiency virus type 1 pharmacogenomics in clinical practice: relevance of
HIV-1 drug resistance testing (Part 1). J Environ Pathol Toxicol Oncol.
2003;22(3):201-34. Review. PubMed PMID: 14529094.

50: Motivala SJ, Hurwitz BE, Llabre MM, Klimas NG, Fletcher MA, Antoni MH,
LeBlanc WG, Schneiderman N. Psychological distress is associated with decreased
memory helper T-cell and B-cell counts in pre-AIDS HIV seropositive men and women
but only in those with low viral load. Psychosom Med. 2003 Jul-Aug;65(4):627-35.
PubMed PMID: 12883114.

51: Pereira DB, Antoni MH, Danielson A, Simon T, Efantis-Potter J, Carver CS,
Durán RE, Ironson G, Klimas N, O’Sullivan MJ. Life stress and cervical squamous
intraepithelial lesions in women with human papillomavirus and human
immunodeficiency virus. Psychosom Med. 2003 May-Jun;65(3):427-34. PubMed PMID:
12764216.

52: Pereira DB, Antoni MH, Danielson A, Simon T, Efantis-Potter J, Carver CS,
Durán RE, Ironson G, Klimas N, Fletcher MA, O’Sullivan MJ. Stress as a predictor
of symptomatic genital herpes virus recurrence in women with human
immunodeficiency virus. J Psychosom Res. 2003 Mar;54(3):237-44. PubMed PMID:
12614833.

53: Cruess DG, Antoni MH, Gonzalez J, Fletcher MA, Klimas N, Duran R, Ironson G,
Schneiderman N. Sleep disturbance mediates the association between psychological
distress and immune status among HIV-positive men and women on combination
antiretroviral therapy. J Psychosom Res. 2003 Mar;54(3):185-9. PubMed PMID:
12614827.
54: Evengård B, Klimas N. Chronic fatigue syndrome: probable pathogenesis and
possible treatments. Drugs. 2002;62(17):2433-46. Review. PubMed PMID: 12421101.
55: Maher KJ, Klimas NG, Hurwitz B, Schiff R, Fletcher MA. Quantitativefluorescence measures for determination of intracellular perforin content. ClinDiagn Lab Immunol. 2002 Nov;9(6):1248-52. PubMed PMID: 12414757; PubMed CentralPMCID: PMC130089.

56: Antoni MH, Cruess DG, Klimas N, Maher K, Cruess S, Kumar M, Lutgendorf S,
Ironson G, Schneiderman N, Fletcher MA. Stress management and immune system
reconstitution in symptomatic HIV-infected gay men over time: effects on
transitional naive T cells (CD4(+)CD45RA(+)CD29(+)). Am J Psychiatry. 2002
Jan;159(1):143-5. PubMed PMID: 11772706.