text:
Release Date: August 1, 2010
Date: August 31, 2012
Suzanne Albrecht, PharmD, MSLIS
Freelance Medical Writer
Woodstock, Illinois
Dr. Albrecht has no actual or potential conflicts of interest in relation to this activity.
Postgraduate Healthcare Education, LLC, does not view the existence of relationships as an implication of bias or that the value of the material is decreased. The content of the activity was planned to be balanced, objective, and scientifically rigorous. Occasionally, authors may express opinions that represent their own viewpoint. Conclusions drawn by participants should be derived from objective analysis of scientific data.
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Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patients' conditions and possible contraindications or dangers in use, review of any applicable manufacturer's product information, and comparison with recommendations of other authorities.
To provide an overview of HIV and AIDS, including clinical features, diagnosis, and treatment strategies.
After completing this activity, the participant should be able to:
AIDS is a serious and
often fatal condition
marked by a severe
compromise in immunity.
Caused by HIV, AIDS was
first recognized in 1981.1
An estimated 1.1 million
people in the United States
were infected with diagnosed
or undiagnosed HIV/AIDS
at the end of 2006. Based
on numbers given by the
34 states that reported new
diagnoses in 2006, the Centers for Disease Control and Prevention (CDC) estimated
an additional 56,300 new cases nationwide in 2006.2 More than 44,000 new cases—74% occurring in males—were diagnosed in those states in 2007.2
Since 2008, all 50 states, the District of Columbia,
and five dependent areas (American Samoa, Guam, the
U.S. Virgin Islands, Puerto Rico, and the Northern
Mariana Islands) have used the same confidential name-based system to report HIV/AIDS data. This facilitates
compilation of data.3
To enable the standardization of reporting and compiling public-health data, HIV is classified into three stages.
In 2008, this classification system was revised and a new
HIV-infection case definition was developed. This definition does not pertain to clinical diagnosis; it is meant for
reportable cases only, to aid in public-health surveillance.4 One criterion for HIV infection in adults and adolescents
aged ≥13 years is a positive result from an HIV antibody
screening test (i.e., enzyme-linked immunosorbent assay
[ELISA]) confirmed by positive result from a supplemental HIV antibody screening test (i.e., Western blot or
indirect immunofluorescence assay). An alternative criterion is a positive result or a report of a detectable quantity
on any of the following HIV virologic tests: HIV nucleic
acid (either DNA or RNA) detection, HIV p24 antigen,
or HIV isolation (culture).4
HIV infection is classified as stage
1, stage 2, stage 3, or stage unknown.
Stage 1 is a CD4 T-cell count
≥500/mcL or CD4 T-cell
percentage of total lymphocytes of ≥29 and no AIDS-defining condition. Stage 2
is a CD4 T-cell count
between 200 and 499 cells/
mcL or CD4 T-cell percentage of total lymphocytes
between 14 and 28 and no
AIDS-defining condition.
Stage 3 (AIDS) is a CD4
T-cell count 200/mcL or
CD4 T-cell percentage of
total lymphocytes of <14 or documentation of an AIDS-defining condition. Stage unknown means that there is
no information on CD4 T-cell count or percentage or on
AIDS-defining conditions. Classification always goes from
less severe to more severe; once an infection has been
classified, it cannot be reclassified to a less severe stage.
If the CD4 T-cell count and the CD4 T-cell percentage
are available but fall into different stages, the more severe
stage is selected.4
HIV is a single-stranded (RNA) retrovirus. Transcription is the process of synthesizing RNA from a DNA template.
In the case of retroviruses, this process is reversed. In HIV,
DNA is synthesized using the viral RNA as a template
via an enzyme called reverse transcriptase (RT).1 There are
two types of HIV: HIV-1 and HIV-2. HIV-1 causes the
majority of AIDS cases.1 HIV-2 is less virulent and less
transmissible, but it still can cause AIDS.1
The replication cycle of HIV-1 is divided into two
phases: the early phase and the late phase. The early phase
starts with the virus entering the cell.5 Glycoprotein 120
(gp120) on the surface of the HIV-1 virus binds to a
primary binding site on CD4 cells.1,5 After binding to
gp120, the virus reacts with a chemokine coreceptor, a
process called tropism.1,5 The two major
coreceptors used by HIV are CC-chemokine receptor 5 (CCR5) and CXC chemokine receptor 4 (CXCR4).1,5,6 HIV strains that affect T cells use CXCR4 as the major coreceptor
(T-tropic, or X4, strains); strains that use CCR5 as the
major coreceptor infect macrophages (M-tropic, or R5,
strains).5,6 Strains that use both receptors are dual-tropic.
A patient may be infected with one of these strains, or
with a mixture of strains. R5 strains, the variants most
often transmitted, are responsible for most sexually transmitted infections.1,6 R5 strains are non–syncytium-inducing (syncytium is a fusion of cells).1
In the early course of HIV infection, R5 is the dominant strain.6 X4 infection occurs later in the disease
progression and is syncytium-inducing.1 Upon interaction
with the coreceptor, there is a conformational change of
the HIV-1 glycoprotein 41 (gp41) that allows fusion of
the viral and cellular membranes.5 Once the viral RNA
enters the cell, RT transcribes the viral RNA into a
double-stranded DNA molecule.
Upon completion of reverse transcription, the DNA is integrated
into the host nuclear chromosomes
via an enzyme called integrase.1,5 Integration is problematic because
it allows for a chronic latent infection. In essence, the HIV is "hidden" in the cells. For this reason,
the ability to cure HIV has been
greatly hampered.1
The late phase of the life cycle
starts with transcription of the viral
DNA to RNA via the host's RNA
polymerase II.5 After replication of
the viral RNA, the necessary proteins are synthesized, resulting in
a nucleocapsid that encompasses
the single-stranded viral RNA.1,5 This is the immature virion, which
buds through the host membrane.1,5 Immature virions are incapable of
infecting host cells.1 Maturation
into infectious virus occurs via an
enzyme called protease.1,5 Ultimately,
most host cells and some uninfected
bystander cells are destroyed through
cell lysis caused by the budding
virions, T lymphocyte–induced cell
killing, formation of syncytia, and
HIV is primarily transmitted sexually, parenterally, or perinatally
(also called vertical transmission).1 For women, the risk
factors are heterosexual sex (83%) and injection-drug use
(16%). For men, the main risk factors are having sex with
men (71%), heterosexual sex (14%), and injection-drug
use (10%).2
With sexual transmission, there is a higher risk with
receptive intercourse than with insertive intercourse.1 There are some strategies for reducing the risk of sexual
transmission. Using a condom reduces the risk of transmitting HIV by 20-fold.1 Circumcision has been estimated
to reduce the risk of HIV transmission by 60%.1 Casual
contact with an infected individual is not a significant
risk factor.1
The use of contaminated needles by drug abusers is
the most common means by which the virus is transmitted parenterally.1 Health care workers have a small risk
of contracting the virus, most commonly by a needlestick. There is a 0.3% risk of transmitting HIV via a percutaneous needlestick injury and a 0.09% risk after exposure to
a mucous membrane.7 Certain factors increase the likelihood of HIV transmission. One factor is exposure to a
larger quantity of infected blood (e.g., from a device—i.e.,
needle—in which blood is visible; a device placed directly
into a vein or artery; or a deep injury); another factor is
exposure to blood from a person with a terminal illness.7 Because the health care system follows rigorous screening
practices, it is extremely rare for parenteral transmission
to occur through blood or tissue products.1
Perinatal, or vertical, transmission occurs when the
virus is transmitted from mother to fetus or infant. This
is the most common cause of pediatric infection.1 Although
transmission can sometimes take place in utero, it most
often occurs close to the time of birth or during birth.1 The virus may also be transmitted through breastfeeding.
For this reason, HIV-positive mothers are discouraged
from breastfeeding.1 Without antiretroviral therapy (ART)
and breastfeeding, there is a 25% risk of mother-to-infant
transmission. ART decreases this risk.1
It is of paramount importance to counsel patients that
even when their viral load is below detectable levels
(approximately 50 copies/mL) and they are asymptomatic,
they are still infectious and should avoid sexual and drug-use behaviors associated with HIV transmission.1
While the clinical presentation of HIV infection can vary,
in 40% to 90% of cases it resembles mononucleosis.
Symptoms include sore throat, fever, fatigue, weight loss,
myalgia, diarrhea, nausea, vomiting, lymphadenopathy,
and night sweats. In 40% to 80% of patients, a morbilliform (measleslike) or maculopapular rash may be visible
on the trunk. A high viral load (106 copies/mL) is present
during primary HIV infection, along with a low CD4
cell count. Symptoms may last up to 2 weeks, and 15%
of patients may require hospitalization.1 Symptoms will
eventually resolve in response to the innate immunologic
reaction to the presence of the virus. Even though plasma
RNA decreases substantially during this time, HIV replication continues at approximately 10 billion viruses per
day, along with the destruction of the immune system.1 In the absence of treatment, the viral load will eventually
stabilize at a certain level called the set point. The set point
corresponds directly to the time of onset of AIDS morbidity and mortality; i.e., the higher the set point, the
worse the prognosis.1
It takes at least 3 to 4 weeks from the time of initial
exposure for the body to develop antibodies to the virus.
By 6 months, 95% of individuals will have manufactured
antibodies against HIV-1.1
A number of tests are available to detect the presence
of HIV infection. The most common is the ELISA, which
detects the presence of antibodies to HIV-1.1 Other
technologies include Western blot and immunofluorescence
assay, which are used as confirmatory tests, and polymerase
chain reaction tests for HIV nucleic acids.1,8 These assays
all require a sample of plasma, serum, or oral fluid.8
In 1996, an anonymous home-testing kit, the Home
Access HIV-1 Test System (also marketed under the name
Home Access HIV-1 Express Test System), was approved
by the FDA. The patient mails in a dried blood spot and
calls for the results in a week. This is currently the only
FDA-approved test kit on the market.8
The CDC has issued recommendations for HIV testing. These recommendations appear below.
Adults and Adolescents: The CDC recommends that,
in all health care settings (e.g., hospital emergency departments, urgent-care clinics, inpatient services, sexually
transmitted disease [STD] clinics, substance-abuse treatment clinics, tuberculosis clinics, other public-health
clinics, community clinics, correctional health care facilities, and primary care settings), HIV screening be performed routinely in all patients aged 13 to 64 years unless
the prevalence of undiagnosed HIV infection in the patient
population of that location has been documented to be
less than 1 in 1,000 patients. If the percentage of undiagnosed individuals is not known, voluntary screening
should be started.
All patients who begin treatment for tuberculosis (TB)
should be routinely screened. All patients receiving treatment for STDs should be screened after each occurrence,
regardless of whether they are engaging in high-risk
behavior.9 Patients engaging in high-risk behaviors (injection-drug users and their sex partners, those who exchange
sex for money or drugs, sex partners of HIV-infected
people, men who have sex with men, and heterosexual
individuals who have had [or whose partner has had]
more than 1 sex partner since their last HIV test) should
be tested at least once per year.9 Patients should be encouraged to be tested before starting a new sexual relationship.
Whenever a health care provider has been exposed to a
patient's blood or bodily fluids, the patient should be
informed of the incident and tested for HIV unless recent
test results are available.9
Testing should be on an opt-out basis, meaning that
the patient should be informed verbally or in writing that
the test will be performed and then be given the option
of declining the test. The informed consent should include
an explanation of HIV infection and the implications of negative or positive results. A separate consent for HIV
testing is not recommended; it should be incorporated
into the patient's general consent form for medical care.
If a patient declines an HIV test, this should be documented in the patient's medical record.9
Adults and Adolescents Presenting With Signs or Symptoms: Diagnostic testing should be performed in all
patients presenting with signs or symptoms of HIV infection or an opportunistic infection characteristic of AIDS.
In this case, a plasma RNA test should be done, along
with an HIV antibody test.9 It should be verbally explained
to the patient that testing will be performed, why testing
is indicated, and what the implications of a positive or
negative result are. The patient should then be given the
opportunity to decline testing. Once the patient has been
informed, his or her general consent for medical treatment
should be considered sufficient for diagnostic HIV testing.
Testing should always be voluntary, and there should be
access to clinical care, prevention counseling, and support
services for patients who test positive.9
Pregnant Women and Their Infants: The CDC recommends that all pregnant women be screened for HIV
infection along with the normal prenatal screens. An
opt-out system should be employed that enables the
patient to decline testing after being informed that testing
is advised.9 The patient should receive verbal or written
information that includes an explanation of HIV infection, a description of interventions that can employed to
prevent mother-to-infant transmission, and an explanation
of positive and negative results.9 If the patient declines
HIV testing, this should be noted in her medical record.
Women should be tested as early as possible during each
pregnancy; a patient who declines should be encouraged
to reconsider at a subsequent visit. A second HIV test
during the third trimester is indicated in patients who
receive health care in areas with a high incidence of HIV/
AIDS in women aged 15 to 45 years; patients who receive
health care in facilities that identify at least 1 HIV-infected
pregnant woman per 1,000; patients who engage in high-risk behaviors; and patients who have signs or symptoms
consistent with acute HIV infection. In the last scenario,
a plasma RNA test should be conducted, along with an
anti-HIV antibody test.9
During labor, a rapid HIV test should be performed
in a patient without a documented HIV status, unless
she opts out. If the results of the rapid test are positive,
prophylactic ART should be started immediately, before
confirmation is received.9
If the mother's HIV status is unknown, a rapid HIV
test should be done on the infant, unless the mother
declines. If positive, prophylactic ART should be started.
It is most effective when initiated within the first 12 hours
after birth.9
HIV infection is monitored using two surrogate markers:
CD4 cell count and viral load. Viral load, which determines the amount of virus in the blood, is reported as
copies of HIV RNA per mL of plasma.1 The extent of
HIV replication is demonstrated by the level of plasma
HIV RNA. The CD4 cell count is measured in cells per
microliter. Higher viral loads are associated with a greater
rate of CD4 cell destruction, whereas the CD4 cell count
is a measure of the damage already done to the immune
system by HIV infection.1 CD4 cell counts and HIV-1
RNA measurements should be determined at baseline.6 The CD4 cell count should be tested every 3 to 4 months
in order to determine when to start ART, response to
therapy, and whether a medication alteration is needed.10 Viral load is the most important indicator of therapeutic
response. Ideally, a patient's viral load should be below
the limit of detection—approximately 50 copies/mL.6,10 This is usually accomplished within 12 to 24 weeks following initiation of ART.10
Since HIV is incurable and can never be completely
cleared from the body, the goals of ART are to maximize
the suppression of viral replication and to preserve immunologic function.6 These goals are usually accomplished
by reducing the plasma HIV-1 RNA level to less than 50
copies/mL and maintaining it at that level.6
ART can prevent vertical transmission of HIV. It also
is used prophylactically in the case of HIV exposure.6
Upon initiation of ART, a condition known as immune
reconstitution syndrome may occur. This is an immune
response to inactive or residual opportunistic infections.
Another phenomenon commonly seen with ART is a
redistribution of fat. Abdominal fat accumulation, dorsocervical fat enlargement (buffalo hump), peripheral
wasting, enlargement of the breasts, and cushingoid
appearance may occur.11 These adverse events are not
specific to any one ART combination; they have been
observed in different combinations.11
There are 32 FDA-approved products on the market
for the treatment of AIDS. These include single agents
and combination products with two or three agents. The
existence of combination products means that it is important to ensure that there is no duplication of ingredients.
The patient should be counseled on each agent and advised
about accidental duplication. Currently, six classes of
drugs are available: nucleoside RT inhibitors (NRTIs), nonnucleoside RT inhibitors (NNRTIs), protease inhibitors (PIs), a fusion inhibitor, an entry inhibitor, and an
integrase strand transfer inhibitor. The patient must be
on more than one medication in order to improve efficacy
and prevent resistance.1
NRTIs work in two ways. Upon phosphorylation, they
compete with the natural substrate of RT. They are then
incorporated in the viral DNA, which results in DNA
chain termination.6,11 As a class, they can cause myopathy,
hepatic steatosis, neuropathy, and lactic acidosis.5 Patients
should be aware of the signs and symptoms of lactic
acidosis, which include weakness, myalgia, dyspnea,
unusual or unexpected stomach discomfort (including
nausea, vomiting, or pain), dizziness, arrhythmia or
tachycardia, and feeling cold (especially the limbs).11 Patients must be counseled that lactic acidosis is a medical emergency.
Currently, seven NRTI moieties are available. Cross-resistance has been documented between members of
this class.5
Emtricitabine (Emtriva): Approved in July 2003. In patients
co-infected with HIV and hepatitis B virus (HBV), there
have been cases of acute exacerbations of HBV upon
discontinuation of emtricitabine. Liver function should
be monitored for several months after the drug is stopped,
and anti-HBV therapy may be needed. Because emtricitabine does not inhibit CYP450 enzymes, no dose adjustment is necessary for hepatic impairment. However, if
the creatinine clearance is less than 50 mL/min or dialysis is required, the dose should be reduced or the dosing
interval should be increased. Emtricitabine may be taken
with or without food and is pregnancy category C.11
Lamivudine (Epivir): Approved in November 1995. Lamivudine is also approved for the treatment of HBV (Epivir-HBV, which contains a lower concentration of the drug).
As with emtricitabine, caution should be exercised when
discontinuing lamivudine in HBV–co-infected patients.
Acute HBV exacerbations may occur. Lamivudine is
primarily eliminated unchanged by the kidneys. Dosing
should be modified in patients with renal impairment.
Hepatic impairment should not require any alteration in
dose. Lamivudine may be taken without regard to food
and is pregnancy category C.12
Zidovudine (Retrovir): Approved in March 1987. Bone-marrow suppression and symptomatic myopathy have
been associated with the use of zidovudine. Patients coinfected with hepatitis C virus (HCV) who are taking
ribavirin have suffered exacerbations of anemia. Some
HCV–co-infected patients taking interferon alfa with or
without ribavirin have experienced hepatic decompensation (sometimes fatal). Dosing may need to be adjusted
for renal or hepatic dysfunction. Zidovudine may be taken
with or without food and is pregnancy category C.13
Didanosine (Videx, Videx EC): Approved in October 1991;
enteric-coated capsule approved in October 2000. Pancreatitis (sometimes fatal) has been associated with the use
of didanosine. Other adverse events include noncirrhotic
portal hypertension and optic neuritis (inflammation of
the optic nerve). In pregnant women, lactic acidosis (fatal)
has occurred when didanosine was given concomitantly
with stavudine. The dose of didanosine should be reduced
for renal impairment. Didanosine must be taken on an
empty stomach and is pregnancy category C.14
Tenofovir (Viread): Approved in October 2001. This
drug is indicated for HBV also. As with emtricitabine
and lamivudine, there have been instances of acute
exacerbations of HBV in co-infected patients upon
stopping tenofovir. Loss of bone mineral density has
been reported with the use of the drug. Tenofovir is
not metabolized by CYP450 enzymes, but the dose
should be reduced for moderate-to-severe renal impairment. The drug may be taken without regard to food
and is pregnancy category B.15
Stavudine (Zerit, Zerit XR): Approved in June 1994.
Pancreatitis has occurred when this drug was taken in
combination with didanosine. It is of interest to note that
pancreatitis has been reported in patients taking didanosine alone. Because stavudine is minimally metabolized
in the liver, dose reduction is not indicated for hepatic
impairment.16 Renal function should be assessed prior to
initiation of tenofovir, as well as regularly throughout
treatment, to determine whether it is necessary to discontinue the drug, modify the dose, or replace it altogether.6 With renal impairment or dialysis, however, a decrease
in dose is recommended. Stavudine may be taken with
or without food and is pregnancy category C.16
Abacavir (Ziagen): Approved in December 1999. Abacavir has been associated with serious, sometimes fatal,
multiorgan hypersensitivity reactions. There is a genetic
predisposition to this reaction, and patients who carry
the HLA-B*5701 allele are at higher risk. However, a
hypersensitivity reaction can take place in someone who
does not have this allele. If a hypersensitivity reaction
occurs, the drug should be stopped and never be restarted.
A medication card must be dispensed with every new prescription and refill. Abacavir is contraindicated in
moderate-to-severe hepatic impairment, and patients
with renal impairment require a dose reduction. Abacavir may be taken without regard to food and is pregnancy category C.17
NNRTIs bind noncompetitively to RT at a different site
than do NRTIs. Because the two classes bind at different
sites, they may be given together.1 There is no benefit to
combining two NNRTIs, however.18 Since NNRTIs are
metabolized by CYP3A (and, in some cases, other CYP
isoforms), there are many drugs that must be used with
caution or avoided altogether. These include ergot derivatives, cisapride, pimozide, St. John's wort, midazolam,
triazolam, clarithromycin, azole antifungals, certain calcium
channel blockers, certain antiarrythmics, warfarin, hydroxymethyl glutaryl coenzyme inhibitors, rifabutin, rifampin,
certain immunosuppressants, phosphodiesterase type 5
inhibitors, and ethinyl estradiol.18-21 This list is not comprehensive. The pharmacist must review each prescription
thoroughly to evaluate other potential interactions. Serious, sometimes fatal, skin reactions can occur with NNRTIs;
overall, however, less toxicity is associated with NNRTIs
than with NRTIs.5 Resistance develops quickly with
NNRTIs, but this may be slowed if NNRTIs are taken
with NRTIs.5
There are four NNRTIs. Cross-resistance has been
documented between members of this class.1
Etavirine (Intelence): Approved in January 2008. Peripheral neuropathy has been reported with the use of etavirine.
No dosage adjustment is required for mild-to-moderate
hepatic or renal impairment. Etavirine should be taken
following a meal and is pregnancy category B.18
Delaviridine (Rescriptor): Approved in April 1997. It
may be given with or without food and is pregnancy
category C.19
Efavirenz (Sustiva): Approved in September 1998. Severe
depression, suicidal ideation, nervous system symptoms
(dizziness, insomnia, impaired concentration, somnolence,
abnormal dreams, hallucinations) can occur within 1 to
2 days of initiation and usually resolve in 2 to 4 weeks.
Taking the drug at bedtime can help alleviate these symptoms. Hepatotoxicity (especially with pre-existing hepatic
disease or co-infection with HBV or HCV), convulsions,
and hyperlipidemia have been reported with efavirenz.
The drug should be taken on an empty stomach. Efavirenz
is pregnancy category D, and fetal harm can occur in the
first trimester.20
Nevirapine (Viramune): Approved in June 1996. Hepatotoxicity, sometimes fatal, has been reported with nevirapine. If hepatotoxicity should occur, the drug should
be stopped and never be restarted. Nevirapine is contraindicated in moderate-to-severe hepatic impairment. There
is no need for dose adjustment for renal impairment.
Nevirapine may be taken without regard to food and is
pregnancy category B.21
PIs bind to the viral enzyme protease in the late phase of
the viral replication life cycle. They prevent cleavage of
the viral Gag and Gag-Pol polyproteins, thereby preventing the maturation of virions. (Only mature virions can
infect other cells.)1,5,22 As a class, PIs have the potential to cause hyperglycemia, hyperlipidemia, and severe (sometimes fatal) skin rashes. The patient may develop diabetes
mellitus (DM) or lose glycemic control of pre-existing
DM. There also have been reports of spontaneous bleeding in patients with hemophilia, and many PIs can cause
clinical hepatitis.22-31 Like NRTIs, PIs are primarily metabolized by the CYP3A enzyme system, so these classes
share some common drug reactions. They have in common those interactions listed for NRTIs. In addition, PIs
interact with fluticasone, salmeterol, alfuzosin, bosentan,
colchicine, certain antacids (including proton pump
inhibitors and H-5 antagonists), and dexamethasone.22-31 There are also other interactions specific to each individual entity. Ritonavir (a PI) inhibits the metabolism of
other PIs, and it is always used in combination with other
PIs to boost their concentration.1
There are currently 10 PIs. Cross-resistance has been
documented between members of this class.22
Amprenavir (Agenerase): Approved in April 1999.
Amprenavir is a sulfonamide. The capsules contain
vitamin E, so patients should be advised not to use
vitamin E supplements. The capsules and oral solution
are not equivalent on a mg-per-mg basis. The oral solution contains a large amount of propylene glycol and
is contraindicated in children under the age of 4 years.
Amprenavir may be taken with or without food; however, it should not be taken with a high-fat meal. The
drug is pregnancy category C, but the oral solution
should not be given to pregnant women owing to its
high propylene glycol content.22
Tipranavir (Aptivus): Approved in June 2005. The drug
has been associated with fatal and nonfatal intracranial
hemorrhages. Like amprenavir, tipranavir is a sulfonamide,
and the oral solution contains vitamin E, which is used
as a surfactant. Tipranavir should not be given to treatment-naïve patients. It is used in patients who are infected
with a strain that is resistant to one or more of the PIs.
Although this has not been studied, there should be no
need for a dose reduction for renal impairment. Tipranavir may be taken without regard to food and is pregnancy
category C.23
Indinavir (Crixivan): Approved in March 1996. Acute
hemolytic anemia, sometimes fatal, has been associated
with this drug. Other things to watch for include nephrolithiasis or urolithiasis, hyperbilirubinemia, and interstitial nephritis. Indinavir should be taken on an empty
stomach, but it may be taken with low-fat, low-calorie
food or drink. It is pregnancy category C.24
Saquinavir (Invirase): Approved in December 1995.
Renal impairment should have no effect on dosing,
although this has not been studied. Saquinavir should
not be taken within 2 hours of a meal and is pregnancy
category B.25
Lopinavir/Ritonavir (Kaletra): Approved in September
2000. Pancreatitis has been reported with the use of
lopinavir/ritonavir. Hyperlipidemia is a risk factor. Since
ritonavir is included in this formulation, all precautions
for ritonavir should be considered. Dose adjustment
for renal impairment should not be necessary with
lopinavir/ritonavir, although this has not been studied.
The product should be taken with food and is pregnancy
category C.26
Fosamprenavir (Lexiva): Approved in October 2003.
Fosamprenavir has been associated with hemolytic
anemia and nephrolithiasis. The tablets may be taken
with or without food, but the oral suspension must be
taken with food in children and without food in adults.
Fosamprenavir is pregnancy category C.27
Ritonavir (Norvir): Approved in March 1996. Pancreatitis has been reported with the use of ritonavir. Ritonavir also has been shown to cause PR interval elongation, so caution must be exercised in patients with
ischemic disease, myopathy, or arrhythmia. No dose
reduction is needed for mild-to-moderate hepatic or
renal insufficiency. Ritonavir should be taken with food
and swallowed whole, not crushed or chewed. It is
pregnancy category B.28
Darunavir (Prezista): Approved in June 2006. Darunavir is a sulfonamide. It does not require a dose adjustment in patients with mild-to-moderate hepatic or renal
impairment. Darunavir is not recommended in patients
with severe hepatic impairment. It should be taken with
food and is pregnancy category C.29
Atazanavir (Reyataz): Approved in June 2003. Most
patients taking atazanavir experience asymptomatic
hyperbilirubinemia, which does not require a dose
reduction. Nephrolithiasis has been reported in patients
taking atazanavir. The drug should not be administered
to patients with severe hepatic impairment, and it is
not recommended in patients with any stage of hepatic
impairment. Atazanavir may require a dose reduction
for renal impairment. It should be taken with food and
is pregnancy category C.30
Nelfinavir (Viracept): Approved in March 1997. Viracept
oral powder contains phenylalanine. Patients with phenylketonuria should avoid the powder dosage form. Dose
reduction probably is not necessary in patients with renal
impairment. Nelfinavir should be taken with food and is
pregnancy category B.31
Currently the only approved (March 2003) fusion inhibitor, enfuvirtide (Fuzeon) prevents fusion of the HIV-1
and CD4 cellular membranes by binding to the viral
gp41 site. If the virus cannot fuse with the cellular
membrane, it cannot enter the cell. Enfuvirtide is injected
subcutaneously twice daily. The injection site must be
rotated each time. The drug does not inhibit CYP450
enzymes, and no dose adjustment is required for hepatic
or renal impairment. It is pregnancy category C.32
Maraviroc (Selzentry) was approved in August 2007. It
blocks the CCR5 chemokine coreceptor, which prevents
R5 HIV-1 from entering the CD4 cells.33 Tropism needs
to be determined to assess whether maraviroc will be of
benefit.6 An allergic reaction resulting in hepatic toxicity
has been reported with maraviroc. An increased risk of
myocardial infarction and ischemic disease also has been
observed. Caution should be used in hepatic impairment
and/or cardiovascular disease. Other adverse reactions are
upper respiratory infections, pyrexia, cough, rash, and
dizziness. A substrate of CYP3A, maraviroc has the potential to interact with medications metabolized by the same
isoform. It may be taken with or without food and is
pregnancy category C.33
Raltegravir (Isentress), approved in October 2007, inhibits the HIV enzyme integrase, thereby rendering viral DNA incapable of being inserted (or integrated) into the
host cell genome. Myopathy and rhabdomyolysis (and
elevated creatinine kinase) have been reported with the
use of raltegravir. Dose adjustment is not necessary for
renal impairment or mild-to-moderate hepatic impairment. It may be taken with or without food and is
pregnancy category C.34
The U.S. Department of Health and Human Services
(DHHS) published updated guidelines for the treatment
of HIV/AIDS in December 2009.10 It is important to
note that research is constantly being done, and ideas
concerning the management of HIV/AIDS change quickly.
Practitioners need to keep abreast of these changes in
order to provide optimal treatment.
Upon initial diagnosis, certain tests should be performed.
These include CD4 cell count, viral load, resistance testing (to determine drug susceptibility), HBV, basic chemistry (electrolytes, blood urea
nitrogen, serum creatinine,
fasting glucose), liver-function tests, fasting lipid profile,
and urinalysis (to determine
renal function).10
When to initiate therapy
is contingent upon many
factors. No evidence points
to any benefit of starting ART
upon initial diagnosis. Things
to be considered include the
number and frequency of
pills, comorbid conditions, expected tolerability of the
regimen, medication costs, expected patient adherence,
and potential adverse events (both long- and short-term).
Once treatment is started, it may not be discontinued.6 The risks of ART are drug toxicity and viral resistance.
There are risks in delaying initiation of ART. Untreated
HIV infection has been shown to be associated with many
non–AIDS-defining conditions such as cardiovascular
disease, kidney disease, liver disease, and malignancy.10
CD4 cell count is used to determine whether a treatment
regimen is working. An increase in CD4 cell count of 50
to 150 cells/mm3 per year is considered an adequate
response. There should be greater progress in the first 3
months.10 CD4 cell count should be tested every 3 to 4
Viral load is used to determine response to ART. This
should be tested within 2 to 4 weeks (but not more than
8 weeks) of initiating treatment. It should then be measured every 4 to 8 weeks until it falls below the limit of
detection. After a regimen is changed, viral load should
be determined within the first 2 to 8 weeks of the alteration. Once the patient is stable on the regimen, viral
load should be rechecked every 3 to 4 months.10
When to initiate treatment should be made on a case-by-case basis. As noted earlier, there are pros and cons to
starting ART early and to delaying ART. The DHHS has
issued guidelines on when to start ART in treatment-naïve
patients (TABLE 1).10
Certain factors must be considered when an initial
ART regimen is being selected. Things that must all be
taken into account are comorbid conditions (cardiovascular disease, chemical dependency, liver disease, psychiatric illness, renal disease, TB); potential drug toxicities;
potential drug interactions; pregnancy status (or potential to become pregnant); results of drug-resistance testing; gender and CD4 cell
count, if considering nevirapine; HLA-B*5701 testing,
if considering abacavir; tropism, if considering maraviroc; patient compliance;
and convenience (pill burden,
dosing schedule, food and
fluid considerations).10 The
DHHS recommends that a
treatment-naïve patient be
placed on two NRTIs and
a ritonavir-boosted PI, an
NNRTI, or an integrase strand transfer inhibitor (presently, only raltegravir is approved).10 The preferred
regimens are tenofovir/emtricitabine (NRTIs) and efavirenz (NNRTI) or atazanavir/ritonavir (or darunavir/ritonavir, if patient is taking >20 mg omeprazole daily)
(PI), or raltegravir.
If there are contraindications or other reasons the
patient cannot be started on one of these regimens, the
DHHS guidelines suggest alternative regimens. These
alternative regimens are effective and tolerable, but are
not considered ideal. The NNRTI-based regimens are
lamivudine/abacavir or zidovudine (NRTI) and efavirenz
(NNRTI) or zidovudine/lamivudine and nevirapine
(NNRTI). The PI-based regimens are lamivudine/abacavir or zidovudine and atazanavir/ritonavir (PI), or fosamprenavir and either lamivudine/abacavir or zidovudine or
tenofovir/emtricitabine, or lopinavir/ritonavir and either
lamivudine/abacavir or zidovudine or tenofovir/emtricitabine, or saquinavir and tenofovir/emtricitabine. There
are other acceptable regimens, but they are less satisfactory and should be used only if any of the above regimens
prove impossible.10
If the patient experiences immunologic failure, the
possible causes need to be assessed. These may include
noncompliance, pharmacokinetic issues (such as drug
interactions, not taking as directed with regard to food,
or malabsorption issues), or
drug resistance.10 Substitutions must be made as appropriate, with consideration
given to exposure to previous
drugs, current medications
(and potential adverse reactions or drug interactions),
resistance testing, and the
patient's ability to adhere to
the medication schedule.
There are guidelines to prevent HIV infection after exposure to the virus. There are guidelines for prophylaxis for
health care workers, for perinatal transmission, and for
nonoccupational exposure. See TABLE 2.
The management of HIV is multifaceted and complex.
Many agents from five different classes of drugs are
available. To maximize efficacy and prevent the development of resistance, a patient needs to be taking at
least two drugs; a three-drug regimen is preferred. The
pharmacist has an integral
role in the management of
HIV-infected patients. Noncompliance is a major reason for the development of
drug resistance; the pharmacist, by scrutinizing the
patient's drug regimen for
duplication, potential interactions, and toxicity, can
work with the patient to
maximize compliance and
therapeutic outcomes. Since
research is ongoing and the concepts regarding the
management of HIV infection are always evolving, it
is the duty of the pharmacist to keep current with
therapeutic guidelines.
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text:
Obituaries fromNavarro County, Texas
Aubrey A. Pollock
Jan 30, 1901 - Nov 1977
Aubrey A. Pollock, 70, of RL2, San Saba, died at 7 a.m.
Wednesday at Hendrick Medical Center. Services are pending with Elliott-Hamil
Funeral Home, 542 Hickory.
Born Jan. 30, 1901, in Corsicana, he retired from Mobil
Oil Co. in 1980 after 40 years of service. He married Ercle Brannon in 1920 in
Corsicana. They moved to San Saba in 1960 from Seminole, where they had lived
for 11 years.
Survivors include his wife; a son, Aubrey E. of
Lovington, N.M.; four brothers, Henry A. of Abilene, Claude and Odie, both of
Corsicana, and Bob of Dallas.
The family will be at 3382 Parcrest.
Abilene Reporter News, 16 Nov 1977
Submitted by
John Barron
Gerald Ray Davis, Sr.
Oct 2, 1935 - Apr 13, 1993
Gerald Davis Sr., 57, of Corsicana died April 13, 1993 at his home.
Services will be 3 p.m. Thursday in the Griffin-Roughton Funeral Chapel with J.
T. Davis officiating. Burial will be in Oakwood Cemetery.
He is survived by his wife Lena Davis of Corsicana; one son, Gerald Davis Jr. of
Corsicana; three daughters, Sharon Croger of Corsicana and Brenda Kowalski and
Sandra Kaiser, both of Broomfield, Colo; three brothers, William Davis of North
Little Rock, Ark, and Butch Davis and Talmage Davis, both of Jacksonville, Ark;
one sister, Carolyn Kariker of North Little Rock, Ark., and nine grandchildren.
Pallbearers will be And Owens, Rand Owens, Don Watkins, Jimmy Hawkins, Mike
Smithey and Wayne Gay.
Gerald Ray Davis Sr.
Gerald Davis Sr., 57, of Corsicana died April 13, 1993 at his home.
Services will be 3 p.m. Thursday in the Griffin-Roughton Funeral Chapel with J.T.
Davis officiating. Burial will be in Oakwood Cemetery.
He is survived by his wife, Lena Davis of Corsicana; one son, Gerald Davis Jr.
of Corsicana; three daughters, Sharon Croger of Corsicana and Brenda Kowalski
and Sandra Kaiser, both of Broomfield, Colo.; three brothers William Davis of
North Little Rock, Ark. and Butch Davis and Talmage Davis, both of Jacksonville,
Ark.; one sister, Carolyn Kariker of North Little Rock, Ark.; and nine
Pallbearers will be Andy Owens, Randy Owens, Don Watkins, Jimmy Hawkins, Mike
Smithey and Wayne Gay.
James Wilburn
Feb 26, 1912 - Apr 1993
Wilburn Buchanan
James Wilburn Bachman, 81, of Ennis.
Services will be 2 p.m. Thursday in the Corley Funeral Chapel in Corsicana with
Dick Moody officiating. Masonic graveside services by the Corsicana Masonic
Lodge #174 will take palce in Richland Cemetery.
He was born Feb 26, 1912 in Navarro County and was a retired track supervisor
with the Southern Pacific Railroad. He was a member of the Corsicana Masonic
Lodge #174.
Survivors include his wife, Grace Buchanan of Ennis; one son and
daughter-in-law, J.R. and Barbara Buchanan of Mexia; two grandsons, Robert
Buchanan of Tomball and Rickey Buchanan of Tennessee Colony; one
great-grandchild, Jesse Buchanan of Tomball, and one sister-in-law, Edna
Buchanan of Channel View.
Pallbearers will be J. W. Atchley, Johnny Wickliffe, Le Roy Griffin, Birgil
Griffin, Billy Griffin and Walter Griffin.
Honorary pallbearers are Virgil Atchley Reamon Cooley, Dennis Miller, Ott Loper,
Ken Woods, Coke Carruthers and Norman O'Rear.
Friends desiring to do so may make contributions to the American Heart
Association, 1615 Stemmons Freeway, Dallas, Texas 75207.
James Thomas
Aug 31, 1857 - Aug 6, 1932
Former Resident Corsicana Will Be Buried Here Sunday
J. T. Parkinson, formerly a resident of Corsicana, died in Dallas at an early
hour Saturday morning, according to information received here Saturday
afternoon. The funeral will be held here sometime Sunday, but definite funeral
arrangements had not been made at press hour Saturday afternoon.
Funeral arrangements are being handle by the Sutherland-McCammon Funeral Home.
Former Corsicana Resident Is Buried in Oakwood Sunday
Funeral services for John Thomas Parkinson, aged 74, native of Mississippi,
formerly resident of Corsicana, she died in Dallas Saturday, were held at
Oakwood cemetery Sunday afternoon at 3 o'clock, where interment was made. He was
a member of the Christian church.
Surviving are his wife, Mrs. Nancy Parkinson, Dallas; two sons, F. I. Parkinson
and M. H. Parkinson, both of Dallas; three daughters, Mrs. Pearl Black, Salt
Lake City; Mrs. Jewell Beville and Mrs. Mattie Barnes both of Dallas; and a
number of grandchildren and other relatives.
Pallbearers were E. B. Wigley, Jeff Wigley and Rufe Wigley, half-brothers, all
of Corsicana; H. J. Parkinson, Jr., grandsons, all of Dallas.
The funeral services here were in charge of the Sutherland-McCammon Funeral
Joshua A. West
Apr 28, 1853 - Aug 4, 1932
Aged Native of Navarro County Buried Friday
Funeral services for J. A. West, aged 79, native of Navarro county who died
Thursday morning at the home of his sister, Mrs. Fannie Stokes, of Emhouse were
held from the sister's residence Friay afternoon at 3 o'clock with interment in
the West cemetery at Grange Hall. The services were conducted by Rev. I. R. Darwood of Eureka and Rev. Bruce Cox of Barry.
Six nephews of the deceased acted as pallbearers, including, R. L. and Durwood
Stokes of Fort Worth; J. E. Stokes of Corsicana; Earl Stokes of Rankin; Lynn
Stokes of Pickett and L. W. Armstrong of Barry.
West, aged 79 years, native of Navarro county, died at the home of
his sister, Mrs. Fannie Stokes, where he made his home, in the
Emhouse community Thursday morning at 11:15 o'clock and the funeral
services will be held from the Stokes home some time Friday with
burial in the West cemetery at Grange Hall, it was learned here
Thursday afternoon by relatives. Surviving are two brothers, J, J,
West, Fort Worth, and A, J. West, Dallas; a sister, Mrs. Stokes, and
a number of nieces and nephews. He was a twin brother of A. J. West
of Dallas. Mr. West was an uncle of J. E. Stokes of Corsicana. Bruce
McCormick of Blooming Grove has charge of the funeral arrangements.
John Wall Welch
Mar 24, 1847 - Feb 18, 1919
Had Ben In Decling Health, But Death Not Expected
From Tuesday's Daily
John Welch, aged seventy-two years and for many years a resident of Corsicana,
was found dead in his bed this morning about 7:30 by his wife. The deceased was
on his side with an arm partially under his head, and looked as though death had
come as he peacefully slept and as if the dreaded messenger had caused neither
pain or the slightest struggle. Mrs. Welch first called her husband to breakfast,
but she received no response, and concluded to let him rest awhile. About that
time a neighbor called to see him on some business and Mrs. Welch went to his
bed and shook him, and found him cold in death.
The deceased is survived by his widow and one son, Preston Welch. He had many
friends who will be pained to know of his passing away.
The funeral services will take from the home tomorrow afternoon at 4 o'clock,
with Rev. B. W. Vining officiating. The I.O.O.F. ill have charge of the services
at the grave. The local union of brick masons will attend in a body.
Remains Interred This Afternoon
The remains of the late John Welch who was found dead in his bed at home
yesterday morning on Thirteenth street, were interred in
Oakwood this afternoon, and was
largely attended. The services at the home were conducted by Rev. B. W. Vining
and concluded at the Grave by the Odd Fellows.
Nancy Eleanor "Nannie" Jackson
abt 1860 - 1916
Mrs. Nannie Jackson, wife of W.D. Jackson, died near Navarro last night after a
lingering illness from cancer of the stomach. The deceased was 56 years of age
and is survived by her husband and several children. The remains ere interred at
the Grape Creek cemetery this afternoon at 3:00.
Rev. John Newton "Newt" Jackson
Sep 22, 1837 - Aug 4, 1921
Was Confederate Veteran and a Methodist.
Rev. J. N. Jackson, who was eighty four years old on the 22nd day of May last,
died at his home near Navarro last night after a long illness. The deceased was
a native of South Carolina, and had lived in Navarro County for twenty-one
years. He was a Confederate veteran and at the battle of Gaines Mills Va., he
was shot through both lungs and was left on the battle field three days and
nights as dead. For many years the deceased was a local preacher of the
Methodist church. The wife of the deceased passed away five years ago, but he
has ten living children as follows. Mrs. W. N. Dorsey, Malakoff; Mrs. A. J.
Stogner, Frost; Mrs. J. L. Caffy, Angus; W. N. Jackson, Navarro; Mrs. Nick Greis,
Wichita Falls; Mrs. B. F. Gullett, Corsicana; Mrs. Arthur Walker, Mildred; J. F.
Jackson and Miss Alma Jackson, Burkburnett, and Mrs. G. H. Liggon of Richland,
South Carolina. The funeral took place this afternoon with interment n the
Grove [Grape]
Creek Cemetery and was largely attended.
h/o Nancy Eleanor
"Nannie" (Ferguson) Jackson married Jan. 15, 1869
Charles Nathaniel
"Doc" Powell
Nov 3, 1859 [or 1857] - Jun 20, 1916
Well Known Citizen Passes Away Very Suddenly
Doc Powell, aged 48, and a well known citizen of Blooming Grove, died there
yesterday after only one hour's illness with heart trouble.
The widow and three children survive.
The remains were interred there this afternoon at four o'clock.
Zetela (Peters) Morris
Jan 19, 1876 - Apr 3, 1943
Funeral services for Mrs. Zetela Morris, who died Sunday in Dallas were held
Monday afternoon at 2 o'clock at Oakwood Cemetery where interment was made.
James Burge officiated.
Surviving are a brother, Robert Johnson; a sister, Mrs. Theresa White; three
nephews, a niece and other relatives.
Pallbearers were J. E. Erwin, T. H. Sanford, R. P. Dacus and Wayne Plunket.
Sutherland-McCammon directed the arrangements.
John Oscar Young
May 28, 1874 - Apr 2, 1943
J. O. Young Rites Held Saturday
Funeral services for J. O. Young age 68 years, who died at 320 West Sixth avenue
Friday afternoon at 3:30 o'clock were held from teh chapel of the Corley Funeral
Home Saturday afternoon at 2 o'clock. Rev. Jack Goff, pastor of the Northside
Baptist Church officiated. Burial was in
White Church Cemetery.
Surviving are four brothers, Clarence Young, Bremon; Tom Young, Houston; Sam
Young, Barry; Frank Young, Corsicana; a sister, Mrs. W. D. Gilliam, Fort Worth
and other relatives.
Henry Cato Montgomery
Nov 1, 1867 - Mar 28, 1943
H. C. Montgomery Buried at Dresden
H. C. Montgomery, about 65 years of age, died in the Raleigh community Sunday.
Funeral services were held Wednesday afternoon with burial in the
Surviving are his wife and several children.
Annie (Jackson) Gates
Aug 28, 1905 - June 11, 1971
DAWSON - Funeral services for Mrs. Annie Gates, 67, of Dawson, will be at 2 p.m.
Wednesday at the Church of God and Christ in Dawson. Elder L. C. Coleman will
officiate with burial in the Dawson Cemetery under the direction of Calhoun
Funeral Home.
Mrs. Gates died Friday in Memorial Hospital.
Lula Ann (Shaddox) Chism
Feb 20. 1888 - June 14, 1971
Mrs. Lula A. Chism, 83, of Richland, died Monday morning at Evergreen Nursing
Home here.
Funeral is pending with Corley Funeral Home.
Survivors include a son, Starlie Chism of Richland; a grandson, R. J. Chism of
Pasadena; two granddaughters; a sister, Mrs Myrtle Stewart of Arkansas; and a
brother, Othel Shadix of Shreveport, La. Her husband R. C. Chism, died last May.
Katie W (Batte) Shields
Feb 14, 1869 - Feb 13, 1919
Lady Passes Away After Four Months of Severe Illness
Mrs. Katie Shields, wife of W. B. Shields, aged forty-nine years, eleven months
and twenty-four days, died at the family home at Eureka at 10:45 last night after
an illness of four months and the remains were interred in the
Hopewell cemetery
this afternoon at 3 o'clock in the presence of a large concourse of friends and
neighbors. The deceased is survived by her husband and eight children.
John Emerson Curington
June 10, 1848 - Feb 9, 1919
Father of Sheriff Curington is Buried At Rural Shade Today
J. E. Curington, aged seventy-one years, died here last night at the home of his
son Sheriff J R. Currington, and the remains were taken to from there the
funeral party went to Rural Shade where the remains were interred. Rev. B. F.
Ellis of Kerens, officiated, and a large crowd attended the funeral.
The deceased came to Navarro county from Alabama in 1882 and had been a citizen
of this county for thirty seven years, and during all those years he was in
every sense a good citizen and was esteemed as one of our best men by all who
knew him.
He is survived by his wife and three children, Sherif J. R. Curington, Bud
Curington, and Mrs. J. A. Berger. The deceased had been in declining health for
many months and was here on a visit to his son when the final summons came.
Doris Cantrell
Jan 21, 1944 - Nov 22, 2009
Norman Lee Stewart
Apr 4, 1963 - Nov 21, 2009
Arnold Ray Bamburg
Sept 25, 1925 - Nov 26, 2009
Arnold Ray Bamburg, 84, of Corsicana passed away Thursday, Nov. 26, 2009,
in Dawson. He went home to his Father after a long battle with cancer. He was
born Sept. 25, 1925, in Corsicana. A private family service was held. Survivors
include his son, Arnold Bamburg and wife Debbie of Corsicana; grandson, Brandon
Djordjevic and wife Kelly of Van Buren, Ark.; granddaughter, Nichole Deyo and
husband Greg of Tyler; grandson, Matthew Calame of Waxahachie; four
great-grandchildren; and numerous family and friends. Arrangements by J. E.
Keever Mortuary, Ennis.
Sonda (Nutt) Davis
May 28, 1938 - Nov 27, 2009
Earl Garvin
Oct 21, 1924 - Nov 25, 2009
Earl Garvin of Lancaster, born Oct. 21, 1924, in Blooming Grove, passed
from this life Wednesday, Nov. 25, 2009. He was preceded in death by parents
Leslie and Pearl Garvin; siblings Sister, Ceil, Faye and twin Ray, John, Sue,
and twin sister Mearl. He is survived by wife Dorothy; daughter Janice Faye
(Don) Trull; sister Billie Jean Christie; grandchildren Tammi (Kirk) Burris and
Terri (James) Scott; great-grandchildren Amanda, Owen, and Levi; and many nieces
and nephews whom he loved dearly. Visitation will be held from 6 to 8 p.m.
Sunday, Nov. 29, at Byrum Funeral Home, 425 N. Dallas Ave., Lancaster. Funeral
services will be held at 10 a.m. Monday, Nov. 30, at Byrum Funeral Chapel.
Interment will be at Frost Cemetery Arrangements by Byrum Funeral Home,
Marshall Ray Hensley
Apr 1, 1953 - Nov 30, 2009
Jack L. Manning
July 28, 1922 - Dec 1, 2009
James Payne
April 18, 1935 - Nov 30, 2009
Janis Marie
(Price) Batts
April 7, 1945 - Dec 1, 2009
Joyce (Deming) Coley
d. Dec 1, 2009
Joyce Deming Coley, beloved wife, mother, grandmother and friend, died on
Tuesday, Dec. 1, 2009. Joyce was a longtime member of First Baptist Church,
teaching Sunday school for over 40 years. Joyce devoted her life to serving her
Lord and family. Joyce leaves behind Howard, her husband of 58 years; one
daughter, Luann Coley Argersinger, and son-in-law, Ray; daughter-in-law, Dawn
Coley; three grandchildren, Sadie and Jonah Coley of Corsicana and Adam
Argersinger of College Station; sister-in-law, Doris Deming of Trinidad; and
several nieces and nephews. She was preceded in death by her sons, Charles
Howard Coley and David Edmond Coley; parents, the Rev J. E. and Myrtle Deming;
brothers, Edmond, Leland, Jim Harry, Max, and Jasper; one infant sister; and a
granddaughter, Amy Argersinger. Visitation will be held from 6 to 8 p.m.
Thursday, Dec. 3, at Griffin-Roughton Funeral Home. Services will be 11 a.m.
Friday, Dec. 4, at Griffin-Roughton Chapel with B.F. Risinger officiating.
Interment will follow at Oakwood
Cemetery. Pallbearers will be Steve Andrus, Mike Dowd, Ray Argersinger,
Terry Williams, Kim Wyatt, Rex Peddy, Craig Tekell and Gary Otterson.
Arrangements by Griffin-Roughton Funeral Home.
Michael Blake Allen
Oct 9, 1977 - Dec 4, 2009
Michael Blake Allen, 32 of Longview passed away Saturday, Dec. 4, 2009, in
Longview. He was born Oct. 9, 1977, in Longview to Dickie and Judy Allen, and
was a lifetime resident of Longview. Visitation will be 4 to 6 p.m. Sunday, Dec.
6, 2009, at Welch Funeral Home in Longview. Services will be 11 a.m. Monday,
Dec. 7, 2009, at Welch Funeral Home in Longview. Interment will follow at 3 p.m.
Monday, Dec. 7, 2009, in the Kerens
Cemetery. Survivors include his parents; brothers, Derek Allen and Jonathan
Allen; grandmother, Lou Davies; aunts and uncles, Donna and Joe Kilcrease, Bobby
and Gail Barnes, Linda Davies and Art Davies; numerous cousins; and second mom
and dad, Karon and Jerry Golden. Memorials may be made to the Arc of Gregg
County, P.O. Box 522, Longview, TX 75606. Arrangements by Welch Funeral Home,
Longview. ∞
Macel Comal (Hiler)
Feb 24, 1928 - Dec 4, 2009
Lewis Williams Jr.
Aug 4, 1929 - Dec 3, 2009
James Walter
Aug 10, 1953 - Dec 5, 2009
Vera (Crocker)
Nov 1, 1924 - Dec 7, 2009
Vera Griffin, 85, of Corsicana passed away Monday, Dec. 7, 2009. She was
born Nov. 1, 1924, in Bazette to Jesse and Alta Crocker. She loved her children,
grandchildren and enjoyed cooking. She was preceded in death by her husbands,
Edgar Lamar Arnold and Ezaradell "Bozo" Griffin; son, Roger Dell Arnold; sister,
Dovie Ovalle; and brother, Ernest Crocker. She is survived by her children, Otis
Lamar Arnold and wife Charlotte and Nell Sparks and husband Bobby; sister,
Dimples Holmes; grandchildren, Brian Arnold and wife Karla, Christie Wolver and
husband Mike, Lisa Zimmerman and Emily Richards; great-grandchildren, Savana
Wolver, Hailey Gilliam, Dani Lee Yakesch, Desiree Boulware, Scott Boulware,
Victoria Arnold, Avarie Baker and Anthony Richards. Visitation will be held from
6 to 8 p.m. Tuesday, Dec. 8, at Griffin-Roughton Funeral Home. Graveside
services will be 2 p.m. Wednesday, Dec. 9, at
Richland Cemetery. Arrangements by
Griffin-Roughton Funeral Home.
Norene (Ross) Paul
Aug 25, 1912 - Dec 5, 2009
Norene Ross Paul, 97, of Dallas passed away Saturday, Dec. 5, 2009. She
was born Aug. 25, 1912, in Frost to Harvey and Mary Ross. She was preceded in
death by her husband, John J. Paul; parents, Harvey and Mary Ross; brothers, W.
A. Ross and Harvey C. Ross; and sisters, Erin Ross Herrington, Edith Ross
Mitchell and Ila Ross Butler. She was born and raised in Frost where she grew up
on there family farm and graduated from Frost High School. She later then moved
to Lake Charles, La., then onto Boston and New York where she spent most of her
adult life. She then moved to Dallas where she made her home. She was a devoted
member of Skillman Avenue Church of Christ. She also enjoyed cooking and home
making and her church family. Graveside service will be 2 p.m. Tuesday, Dec. 8,
at Frost Cemetery. Arrangements by
Griffin-Roughton Funeral Home.
Jack Alter Ormsby
Feb 19, 1926 - Dec 6, 2009
Margaret Louise (McDowell) Frazier-Strange
Oct 2, 1926 - Dec 8, 2009
Joseph Lewis
July 27, 2009 - Dec 7, 2009
Joseph Lewis Gonzales, son of Eugene Joseph Gonzales Jr. and Vanessa
Louise Tucker, passed away in Corsicana on Monday, Dec. 7, 2009. He was born
July 27, 2009, in Ennis.He is survived by his parents; brother, Damon Tucker of
Ennis; sister, Mikaylah Guerrero of Ennis; paternal grandparents, Eugene and
Debbie Gonzales of Corsicana; maternal grandparents, Brenda and Tim Taylor of
Ennis; great-grandmothers, Martha Bankston of Ennis and Nona Cullefer of
Corsicana; and numerous aunts and uncles.Joseph was preceded in death by his
grandfather, Michael McCaffety; great-great-grandmother, Mary Bankston;
great-aunt, Stella Eastman; and great-grandparents, Roy and Geneva Ortega.
Services will be held at 2 p.m. Friday, Dec. 11, at Boze-Mitchell-McKibbin
Chapel in Ennis, with the Rev. Tim Grant officiating. Interment will follow at
Calvary Cemetery in Corsicana.The
family will receive friends from 10 a.m. to noon Friday, Dec. 11, at the funeral
home. Arrangements by Boze-Mitchell-McKibbin Funeral Home, Ennis.
Marshel Lee Guinn
Aug 15, 1920 - Dec 6, 2009
Marshel Lee Guinn of Barry passed away Sunday, Dec. 6, 2009, at the age of
89.Born in Byars, Okla., Aug. 15, 1920, to James and Elsie Guinn, Marshel was a
United States Marine veteran of World
War II serving seven years from 1940 to 1947 in the South Pacific. He was an
avid outdoor adventurer and enjoyed fishing and bird hunting. He spent his
working career with Warren Petroleum and City Service Oil Company as a plant
manager. Marshel was preceded in death by his wife Loretta Keuhner Guinn. He is
survived by his son Gary Guinn and daughter-in-law Kara Guinn of Barry;
grandsons Jay Guinn and wife Michelle Guinn of Conroe, Toby Scott Guinn of
Knoxville, Tenn., and their mother Sue Petrie of Knoxville, Tenn., and
granddaughter Katelyn Guinn of Barry; great-grandchildren Morgan and Mason Guinn
of Conroe; cousins Geneva Townsend and Orville Guinn of Red Bay, Ala.; nieces
and nephews Gena Guinn Sawyer of Sulphur Springs, Charles and Judy Guinn Meyers
of Hereford, Mitch Guinn of Denver, Colo., and Larry Guinn of Harrah, Okla. He
was a loving husband, father, and friend; and he will be greatly missed by
everyone. A private memorial service will be held at 2:30 p.m. Monday, Dec. 14,
at Dresden Methodist Church officiated by Pastor Kirk Curry of First Family
Hospice. In lieu of flowers, donations can be made to the Vietnam Veterans of
America Corsicana Chapter 1009, P.O. Box 1086, Corsicana, TX 75151. Arrangements
by Corley Funeral Home.
Martie (Pittman)
Dec 1, 1954 - Dec 5, 2009
Dona Leigh
(Nutt) Willits
June 26, 1963 - Dec 5, 2009
Michael Bailey
May 24, 1950 - Dec 9, 2009
James Dexter
"Jim" Browning
Mar 7, 1936 - Nov 29, 2009
Tyler Robertson Smith
Dec 31, 1986 - Dec 10, 2009
Richard R Varnell
Aug. 3, 1911-Dec. 18, 1966
RR Varnell Dies Sunday In VA
RR Varnell, former local furniture
merchant, died in the VA Hospital at Lisbon
(Dallas) late Sunday night following an
extended illness. He was a native of Barry, son of the late Mr. And Mrs. Walter
Funeral services will be held
Thursday at 2 p. M. From the Corley Funeral Chapel with burial in
Memorial Park.
The rites will be conducted by Rev.
Sidney Roberts, pastor of the First Methodist church, of which he was a member.
Varnell was a Mason, Shriner, and
Methodist. He attended Trinity
University and Baylor School of Medicine
and graduated at Texas Tech.
He was a veteran of the USAF in
World War II.
Surviving are his wife of Corsican,
two brothers, WT Varnell, Odessa and EW Varnell, Sioux City, Iowa; two nieces,
Nancy and Lisa Varnell, both of Sioux City, and other relatives.
Members of the Barry Masonic Lodge
will be pallbearers while members of the Navarro County Shrine Association will
be honorary pallbearers.
Corsicana Daily Sun,
December 19, 1966
Submitted by
Dana Stubbs
WWII Biography
Alpha M. Forgerson
Mar 20, 1921 - Dec 12, 2009
Charles Eugene
"Gene" Gilmore
Feb 10, 1933 - Dec 4, 2009
Charles Eugene "Gene" Gilmore, 76, of Temple passed away Friday, Dec. 4,
2009, at a Temple hospital. Mr. Gilmore was born Feb. 10, 1933, in Bullard to
Chester Monroe and Flora Blanche (Ivy) Gilmore. He served his country in the
U.S. Army during the Korean Conflict. He
was awarded the National Defense Service Medal. He retired from the United
States Postal Service and worked as a security guard in Corsicana before moving
to Temple 21 years ago. Mr. Gilmore was preceded in death by his parents. He is
survived by his sons, Kevin Gilmore and wife Debbie of Temple and Martin Gilmore
and wife Tina of High Point, N.C.; and grandchildren, Rob Gilmore, Steven
Gilmore, Cameron Gilmore, Hayley Gilmore and Hannah Gilmore. Services were held
at 10 a.m. Monday, Dec. 7, at Harper-Talasek Funeral Home in Temple with the
Rev. Sam Callaway officiating. Interment followed at 2 p.m. Monday, Dec. 7, at
Resthaven Memorial Park in
Corsicana with the Rev. Larry Talbert officiating. Arrangements by Harper-Talasek
Funeral Home, Temple.
Arlene (Winters) Nance
June 10, 1918 - Dec 11, 2009
Charles Hayden Young
Apr 19, 1928 - Dec 12, 2009
Totsy (Tinkle)
Apr 14, 1926 - Dec 12, 2009
Totsy Elliott, 83, of Corsicana passed away Saturday, Dec. 12, 2009, in
Houston. She was born April 14, 1926, in Emhouse to Newell and Bird Tinkle. She
was a longtime active member of Westminster Presbyterian Church, a member of the
Kinsloe House, and a member of the Daughters of the American Revolution James
Blair Chapter. After high school she was employed by Chance Vought Aircraft in
Grand Prairie, and she concluded her career at Bethlehem Steel Plant in
Corsicana. She is survived by her husband, Spencer Elliott; a son, Phillip
Elliott; two granddaughters, Claire Elliott and Maggie Elliott; and a sister,
Gerry Canant. Visitation will be held from 6 to 8 p.m. Tuesday, Dec. 15, at
Corley Funeral Home. Services will 10 a.m. Wednesday, Dec. 16, at Corley Funeral
Chapel with the Rev. Darla Blatnik officiating. Interment will be at
Oakwood Cemetery. Arrangements by
Corley Funeral Home.
Merle (Bedford) Estes
Jan 10, 1919 - Dec 14, 2009
Betty Jean (Odle)
Apr 22, 1942 - Dec 12, 2009
Telzy "Buddy" Joles
Aug 9, 1921 - Dec 13, 2009
Miquela "Mickey"
Feb 9, 1928 - Dec 13, 2009
John Walter Nelson
Mar 17, 1918 - Dec 16, 2009
(Young) Dunbar Brown
Feb. 24, 1927 - Dec 13, 2009
Charlys (Allen)
Hughes, R.N.
Aug 22, 1926 - Dec 17, 2009
Charlys Allen Hughes, R.N., 83, went to be with her Lord on Thursday, Dec.
17, 2009, with her family by her side. She was born Aug. 22, 1926, in Emhouse to
Dave and Gertrude Allen. Charlys graduated from Emhouse High School and went on
to nursing school at Scott and White Hospital, in Temple. After graduating she
spent most of her medical career at Medical Arts Clinic and also working in the
surgical department of the Navarro Hospital. Charlys was a member of the First
Baptist Church of Corsicana. She sang in the choir for many years. She was a
member of the Corsicana Chapter No. 118, Order of the Eastern Star for over 53
years. Charlys had a passion for playing the piano. It was a joy for anyone who
was fortunate enough to hear her play. She and Dee loved their farm and had many
happy years sharing it.She was preceded in death by her son, Darrell Harris
Hughes Jr., on Aug. 23, 1969; and her husband, Darrell H. "Dee" Hughes Sr. on
Dec. 13, 1999. Dee and Charlys had been married 51 years at the time of his
passing. She was also preceded in death by sisters, Kathryn Pope and Bess
Harvey, and her parents, Dave and Gertrude Allen. She is survived by her
daughter, Yolanda Norwood and husband Thomas Dewey Norwood of Red Oak;
granddaughter, Amanda Rae Norwood of Chicago, Ill.; one younger sister, Rosalie
Gillen of Emhouse; many nieces and nephews, and also her beloved Gabby.
Visitation will be held from 6 to 8 p.m. Friday, Dec. 18, at Corley Funeral
Home. Services will be 2 p.m. Saturday, Dec. 19, at Corley Funeral Home Chapel
with the Rev. B.F. Risinger officiating. Interment will be at
Oakwood Cemetery. Pallbearers will
be Terry Williams, Don Tekell, James Price, J. Waterman, Jay Justice and Scott
Middleton. Arrangements by Corley Funeral Home.
William "Big
Red" Jones Jr.
June 11, 1945 - Dec 11, 2009
Olin Alva Taylor
Sept 8, 1917 - Dec 14, 2009
Sarah (Pearson)
June 7, 1924 - Dec 8, 2009
Sarah Pearson Adams of Rockville, Md., passed away on Tuesday, Dec. 8,
2009, in San Antonio. She was born June 7, 1924, in Corsicana. Calesta Pearson
was her mother and Pearl Burson her grandmother, and they owned the Burson and
Pearson Florist in Corsicana for many years. Beloved wife of the late Clarence
Joseph Adams, Sarah was the loving mother of Jerry Adams, Paul Adams (partner
Robert Rourke), Lee Adams (Mary), and John Adams (Sue). Mrs. Adams is survived
by six grandchildren, Julie, Jenny, Christopher, Mark, Drew and Wesley. She is
also survived by her sister, Jane Miller of Corsicana; and brother, Joe Pearson
of Lufkin. The family will receive friends from 3 to 5 p.m. Sunday, Dec. 20,
with family reflections at 4 p.m. at Pumphrey's Colonial Funeral Home in
Rockville, Md. Graveside service will be held at 3 p.m. Monday, Dec. 21, at
Arlington National Cemetery. All who plan to attend should meet at
administration building at 2:30 p.m. Arrangements by Pumphrey Funeral Home,
Rockville, Md.
Michael Lloyd
Butler Sr.
July 18, 1942 - Dec 17, 2009
Juanita (Stanley)
July 5, 1926 - July 9, 2008
Jesse Ruben Raines
Oct 16, 1933 - July 16, 1992
HILLSBORO - Jesse Ruben Raines, of Hillsboro and formerly of Palestine,
died Thursday at a local nursing home. He was 58.
Services will be 2 p.m. today at Edens funeral Home chapel, the Rev. Paul
Dickson officiating. burial will be at
Dresden Cemetery in Navarro County.
Mr. Raines was born Oct 16, 1933 in Meridian. He grew up in Frost where he
married Darlene O'Neal on Feb 15, 1955. Mr. Raines was a maintenance manager for
American Plant Food for 13 years and a member of the Prairie Grove Baptist
Church in Emmett.
Survivors include his wife; his father, James Anderson Raines, of Palestine; two
sons, Joel Raines and Jeff Raines, both of Palestine; two daughters, Julie
Pritchett and Ginger Lee, both of Palestine; two brothers, C. W. Raines of
Athens and Nat Raines of Corsicana; three sisters, Juanita Creel and Mary Price,
both of Palestine, and Rachel Belshaw of Haward, Calif.; and eight
Mr. Jessie Ruben Raines, 58, of Hillsboro died July 16, 1992 in
Funeral services will be held at 2 p.m. Friday at Edens Funeral Home
Chapel in Hillsboro with the Rev. Paul Dickson officiating. Burial
will be in
Dresden Cemetery.
He was born Oct. 16, 1933 in Meridian, Tex., the son of James
Anderson and Julie M. Lindsey Raines. He grew up in Frost and
graduated from high school there. He ranched most of his life and
worked as a maintenance manager for American Plant Food for 13
years. He was a member of the Prairie Grove Baptist Church in
Survivors include his wife, Darlene Raines of Hillsboro; his father,
James Anderson Raines of Palestine; two sons, Joel Raines and Jeff
Raines, both of Palestine, two daughters, Julie Pritchett and Ginger
Lee, both of Palestine; two brothers, C.W. Raines of Athens and Nat
Raines of Corsicana; three sisters, Juanita Creel and Mary Price,
both of Palestine, and Rachel Belshaw of Hayward, Calif.; eight
grandchildren; and numerous nieces and nephews.
Memorial may be made to the American Cancer Society.
Oliver Lee Albritton
Jan 1, 1881 - Jul 20, 1960
Hold Services O L Albritton Here Thursday
Funeral services for O L Albritton, 79, native of Navarro County, who died
Wednesday morning, were held Thursday at 10 a.m. from the First Methodist
church, of which he was a member.
The rites were conducted by Dr. E. F. Bohmfalk, pastor of the Austin Avenue
Methodist church, Waco, and Dr. Floyd E. Johnson, pastor. Burial was in
A native of Bazette, Albritton had been an educator, rancher, oil man and civic
leader here for most of his life. He formerly was superintendent of the Frost
school system and served as Navarro county school superintendent.
Albritton was perhaps the one person in Navarro County most responsible for the
establishment and growth of Navarro Junior College. He served as its first
chairman of the board of trustees and continued his interest in the institution
after he left the board.
He was a director of the First National bank, charter member of the Rotary club
and served on the YMCA, Chamber of Commerce and other boards, and was a member
of the draft board and a Mason.
HE was a graduate of Sam Houston State Teachers College, Huntsville.
Albritton was the owner of the Circle A Ranch in the Rural Shade community on
Trinity river in southeast Navarro county.
Surviving are his wife; a son, Oliver, both of Corsicana; a brother, C. C.
Albritton, Dallas; a sister, Mrs. Pearl Burson, Corsicana; and other relatives.
The First National Bank was closed during the funeral hour.
Pallbearers were Ralph Brown, Ralph Stell, Frank Brock, J. N. Garitty, M. S.
Cook, David Brown, Glenn Hawkins, Joseph Pearson, Dee Scott and Ed M. Polk.
Corley directed.
Dan Hamill, Dr.
Mar 20, 1889 - Jan 3, 1982
Dr. Dan B. Hamill, who practiced medicine in Corsicana for 49 years, died early
Graveside services were held Monday at 11 a. m. at
cemetery. The family
has requested that memorials be made to the American Medical Association
Education and Research Foundation or St. John's Episcopal Church.
Dr. Hamill was a member emeritus of the staff of Navarro County Memorial
Hospital where he performed the first surgery, an appendectomy, on Aug. 12,
1952, when the then new hospital opened.
On Aug. 3, 1923, Dr. Hamill came by Interurban from Dallas to begin his practice
A native of Grapevine born March 20, 1898, he graduated in 1916 from Weatherford
High School, and graduated in 1921 from Baylor Medical College in Dallas after
attending the University of Texas in Austin. He interned at Receiving Hospital
in Detroit, Mich.
He and the former Gladys Eugenia Mason, of Rome, New York, were married on
Valentine's Day 1924.
Dr. Hamill is survived by his wife, Corsicana; a daughter, Mrs. Home B. Jester;
a grandson, Dam Hamill Jester, Dallas; a granddaughter, Mrs. F. B. Inks III,
Austin, and a great-grandson, Robert Riley Inks, Austin; and three sisters, Mrs.
J. M. Wilfong, Mrs. J. S. Seneker and Mrs. S. W. Preston.
During World War II, Dr. Hamill served three years in the US Navy, including 19
months in the South Pacific in Australia and New Guinea.
Dr. Hamill was a life member of the American Medical Association and also the
Interstate Post Graduate Medical Assembly.
An interview by the Daily Sun in August, 1973, a year following his retirement,
quoted him as saying he was inspired as a young boy to serve humanity when he
grew up by a family doctor who made his rounds in a buggy with a high stepping
black horse. His associates in the profession, the hospital staff and his
countless patients over the year attested that he had fulfilled the goal in good
measure. A longtime nurse was quoted in the story as saying that frequently Dr.
Hamill would tell the staff if any patient needed attention and their own
physician was unreachable for any reason, just call him.
Gladys Eugenia (Mason) Hamill
Dec 5, 1897 - Jan 14, 1993
Gladys Eugenia Mason Hamill, 95, of Corsicana, died Jan. 14, 1993, in Corsicana.
Graveside services will be 2 p.m. Saturday in
cemetery, with the Rev.
John Scarfs officiating. Corley Funeral Home is in charge of arrangements.
Graveside services will be 2 p.m. Saturday in Oakwood Cemetery, with the Rev.
John Scarfs officiating. Corley Funeral Home is in charge of arrangements.
She was born Dec 5, 1897, in Rome, N.Y. She was a past president of the Kinsloe
House, having served in 1944 and 1945. She was a member of the 19 Century Club
and St. John's Episcopal Church.
She was preceded in death by her husband, Dr. Dan Hamill.
Survivors include one daughter, Mrs. Homer B. Jester of Dallas; one
granddaughter, Mrs. Lloyd Inks III of Austin; one grandson Dan Hamill Jester of
New York City; and three great-grandchildren.
Donations may be made to St. John's Episcopal Church, 104 N. 14th St. Corsicana,
Texas 75110, or to Twilight Nursing Home, 3001 W. Fourth Ave., Corsicana, Texas
Robert Oscar Threet
Jul 30, 1907 -
Jul 18, 1936
Funeral services for Robert Threet, aged 28 years, native of Corsicana and
former employee of the Corsicana Daily Sun, who was killed in an oil field
accident near Wink shortly before noon Saturday, are to be held from the
residence of Mr. and Mrs. W. H. Castles, 1006 North Beaton street, Monday
afternoon at 5 o'clock, with interment in
cemetery. The rites are to be
conducted by Rev. W. R. Hall, pastor of the First Presbyterian church.
Threet was an employee of the Shell Oil Company as a guager and is reported to
have fallen into an oil tank containing a quantity of oil and gas. The accident
occurred Saturday morning at 11 o'clock and he died shortly before noon.
Surviving are his wife, formerly Tillie Castles of Corsicana; parents, Mr. and
Mrs. W. O. Threat, Phillips Chapel; two sisters, Mrs. Ruby Bryant, Longview, and
Mrs. Garnet Farmer, Eureka, and other relatives.
Singers are to be Charlton E. Gunter, Mrs. Boyce Martin, Mrs. A. L. Absher, and
E. E. Burkhart.
Pallbearers are to be Lester Atkins, J. T. Cavender, Dave Levy, Fred DuBose, Guy
Bunch, Jake Cook, Ralph Burrow, and Raymond Bonner.
Sutherland-McCammon Funeral Home in charge of arrangements.
William Thomas Shell, Sr.
Feb 3, 1898 - Jul 3, 1952
Dr. W. T. Shell, Sr. Expires; Funeral Friday At 10 A.M.
Dr. William Thomas Shell, Sr., 78, long-time prominent physician and surgeon,
died at his home, 756 West Third Avenue at an early hour Thursday morning.
Funeral services will be held from the First Baptist Church at 10 a. m. Friday
with burial in Oakwood
The rites will be conducted by Rev. W. M. Shamburger, pastor.
Masons will have charge of graveside rites.
Native of Alabama
Dr. Shall was born at Pigeon Creek, Ala., February 3, 1874, the son of R. D. and
Delilah Shell. After preparatory work in Howard College, East Lake, Ala., he
attended the Emory University School of Medicine and was awarded his MD degree
in 1895.
Coming to Corsicana in 1896, Dr. Shell has headed the Corsicana Hospital and
Clinic since its organization in 1927. He attended post graduate clinics in New
York, Harvard Medical School, keeping abreast with the medical developments in
his field.
Dr. Shell held a Fellowship in the American College of Surgeons.
Given Many Honors
Serving as president of the board of managers of the Navarro County Hospital (P
and S Hospital) when that institution was established, he held that post until
1920. He was secretary-treasurer of the Navarro County Medical Society 1900-1907
and 1909-1912. He was president of the county group in 1907, and served as
secretary-treasurer of the Central Texas Medical Society in 1906 and president
in 1925.
He also held membership in the North Texas Medical Society, Texas Medical
Association, Southern Medical Association, and the American Medical Association.
Railroad Surgeon
Dr. Shell was local surgeon for the Sr. Louis-Southwestern Railway Company of
Texas (Cotton Belt), and the Burlington-Rock Island Lines.
He was a 32 degree Mason and Knight Commander of the Court of Honor, and had
been a member of Corsican Lodge No. 63, IOO, since 1898, receiving a 50-year
jewel two years ago. He was a member of the First Baptist Church and formerly
was a member of the Lions Club.
Dr. Shell served as city health officer 1909-1913.
Surviving are his wife, two sons, Dr. Wm. T. Shell, Jr., and Rufus D. Shell, all
of Corsicana; a daughter, Mrs. J. B. Ellett, Dallas, six grandchildren, one
great-grandchildren, and four sisters, Mrs. Viola Pollard, Mrs. Pearl Jernigan
and Mrs. Ella Jones, all of Greenville, Ala., and Mrs. Gertrude Foster, La
Verne, Ala., and other relatives.
Pallbearers will be R. D. Fleming, Ed Rittersbacher, J. N. Edens, Jr., Judge A.
P. Mays, Eliot Johnston, Dr. Wm. B. Mayfield, J. D. Poindexter, J. N. Edens,
Sr., and Fred M. Allison, Jr.
Griffin will direct.
W. T. Shell, Sr.Funeral Services Held Friday For Dr. W. T. Shell, Sr.Funeral services for Dr. William Thomas Shell, Sr. 78, prominent physician and
surgeon, who died at his home early Thursday, were held at 10 a.m. Friday from
the First Baptist church.The rites were conducted by Rev. W. M. Shamburger, pastor. The Scottish Rite
Rose Croix service was conducted at the grave.Native of Alabama, Dr. Shell came to Corsicana in 1896, the year following his
receiving a MD degree from Emory University School of Medicine at Atlanta, Ga.Long prominent in local, district and state medical societies, Dr. Shell had
headed the Corsicana Hospital and Clinic since its organization in 1927, and was
president of the Navarro County board of hospital managers when the P and S
Hospital was established. He was one of the organizers of the Navarro County
Medical Society and served as its secretary 1900-1907 and 1909-1912. He was
president of the society in 1907 and served as president of the Central Texas
Medical Society in 1925. He was city health officer 1909-1913. Dr. Shell was a member of the local, Central Texas, Texas and American Medical
societies and was a Fellow of the American College of Surgeons. He was local
surgeon for the St. Louis-Southwestern Railway Co. of Texas and the
Burlington-Rock Island Lines.A 32 degree Mason and Knight Commander of the Court of Honor, Dr. Shell also had
been a member of Corsicana Lodge No. 63, IOOF, more than 50 years.Surviving are his wife; two sons, Dr. William T. Shell, Jr. and Rufus D. Shell,
all of Corsicana; a daughter, Mrs. J. B. Ellett, Dallas; six grandchildren, one
great-grandchild, and four sisters, Mrs. Viola Pollard, Mrs. Pearl Jernigan, and
Mrs. Ella Jones all of Greenville, Ala., and Mrs. Gertrude Foster, La Verne,
Ala., and other relatives.Pallbearers were R. D. Fleming, Ed Rittersbacher, J. N. Edens, Jr., Judge A. P.
Mays, Eliot Johnson, Dr. Wm. B. Mayfield, J. D. Poindexter, J. N. Edens, Sr.,
and Fred M. Allison.Griffin Funeral Home directed.
William Thomas Shell, Jr.Sep 24, 1901 - Mar 5, 1963Dr. W. T. Shell Is Found Dead Late TuesdayDr. Wm. T. Shell, Jr., 61, Corsicana native, was found dead at his home, 2411
Park Row, Tuesday about 7 p. m. by his negro house-boy, Jerald Carter, Howe
French, justice of the peace, who conducted an inquest, stated Wednesday
morning. Judge French returned his coroner's verdict that death was from
"natural causes."The house-boy said Dr. Shell had gone to bed during the afternoon and he (the
house-boy) returned about 5 p.m. and thought his employer was asleep and when he
returned two hours later, he discovered Dr. Shell was dead and summoned a
physician.Dr. Shell headed the Corsicana Hospital and Clinic for years. He was educated at the University of Texas and University of Pennsylvania,
receiving a bachelor of arts from Texas and his MD from Pennsylvania. He also
was a Fellow in the American College of Surgeons and attended numerous post
graduate clinics. He was a member of the Kappa Sigma fraternity, First Methodist
church and was a past master of the local Masonic Lodge and a 32 degree Mason.
He was a member of Corsicana Lodge No. 63, IOOF. Dr. Shell was a former
president of the Navarro County Medical Society and served several years as
Corsicana city health officer.Graveside services will be held at
cemetery Thursday at 10 a.m. The
rites will be conducted by Rev. John W. Ford, Corsicana Methodist district
superintendent, assisted by Rev. Floyd A. Boulware, pastor of the First
Methodist church.Surviving are his wife; two daughters, Mrs. Billy Jack Curtis, Austin, and Mrs.
Harold (Toppy) Watson, Jr., Maracaibo, Venezuela; two grandsons, Tres and Bill
Watson, both of Maracaibo, Venezuela; a brother, Rufus D. Shell, Corsicana.Pallbearers will be J. N. Edens, Jr., Ed Rittersbacher, J. Floyd Smith, Fred M.
Allison, Jr., Wade Blackford, Kelly Cawthon, A. P. Mays and Dr. Paul Mitchell.Griffin Funeral Home will direct.
Akron Byrd
Sep 24, 1880 - June 19, 1959
E A Byrd Dies Early Friday
E A Byrd, 78, retired Lone Star Gas Company employee, 1210
West Eleventh avenue, was dead on arrival at Memorial hospital at 2:40 a.m.
Funeral services will Sunday at 3 p. m. from the Eleventh
Avenue Methodist church, of which he was a member, with burial in the
cemetery. He was a member of the Eureka Masonic Lodge.
The rites will be conducted by Rev. Thad Son, Line Street
Methodist church, Hillsboro, formerly of the local church, assisted by Rev. Paul
Wiseman, new pastor here.
Surviving are his wife of Corsicana; two sons, James Byrd,
Angleton, and DV Byrd, Las Vegas, Nev., US Air Force; a daughter, Mrs. Robert
Daniel, Corsicana; three grandchildren and a number of other relatives.
Masons will have charge of gravesides services and will
provide pallbearers.
Griffin will direct.
June 17,
Corsicana Daily Sun
by Dana (Bell) Stubbs
Death Certificate
Joseph Claude Davidson
June 18, 1882 - June 16, 1959
Joe Davidson Dies Tuesday
J C (Joe) Davidson, 73, Richland, retired Missouri Pacific
Railroad bridge carpenter, died in Memorial Hospital Tuesday night.
Funeral services will be held Friday at 3:30 p. m. from the
First Baptist church in Richland with burial in the
Richland Cemetery.
The rites will be conducted by Rev. Marion Ford and Rev. C.
Eidson Donnell.
Surviving are his wife of Richland; two sons, J C Davidson,
Jr., Pendleton, Ore.; and Alden Davidson, Seattle, Wash.; three daughters, Mrs.
Melvin Johnson, Kinder, La.; Mrs. Paul Haynes, Nashville, Tenn.; and Mrs.
Garland Montfort, Mildred; 13 grandchildren; three great-grandchildren and a
number of nieces, nephews and other relatives.
Corley Funeral Chapel directed.
June 17, 1959,
Corsicana Daily Sun
Submitted by Dana
(Bell) Stubbs
J C Davidson Rites Friday
Funeral services for JC (Joe) Davidson, 76, of Richland,
were held at 3 p. m. Friday from the First Baptist church in Richland. Davidson
died in Memorial Hospital Tuesday night.
Rites were conducted by Rev. Marion Ford and Rev. C. Eidson
Donnell, Burial was to be in Richland Cemetery.
Surviving are his wife of Richland; two sons, JC Davidson,
Jr., Pendleton, Ore.; and Alden Davidson, Seattle, Wash.; three daughters, Mrs.
Melvin Johnson, Kinder, La.; Mrs. Paul Haynes, Nashville, Tenn.; and Mrs.
Garland Montfort, Mildred; 13 grandchildren; three great-grandchildren and a
number of other relatives.
Pallbearers were Neal Brown, Guy Campbell, Arthur Patrick,
Jr., Walter L. Hendon, Bill D. Howard and Jack White.
Davidson was a retired bridge carpenter for the Missouri
Pacific Railroad company.
June 18, 1959,
Corsicana Daily Sun
(Bird) Sutherland
Feb 8, 1859 - June 17, 1936
Rites Planned For Mrs. Sutherland at 5 p. m. Thursday
Native Navarro County and Resident Corsicana Many Years
Funeral services for Mrs. CG Sutherland, aged 77 years, 502
North Beaton street, who died in the Navarro Clinic at an early hour Wednesday
morning are scheduled to be held from the First Presbyterian church Thursday
afternoon at 5 o'clock with interment in Oakwood
cemetery. The rites will be
conducted by Rev. WR Hall, pastor of the church. Mrs. Sutherland had been a
long-time member of the First Presbyterian church.
Mrs. Sutherland was a native of Navarro county and had
resided in Corsicana practically all of her life. She was the widow of the late
Bank Sutherland, pioneer merchant and funeral director of Corsicana, and long an
active leader and official of the IOOF in Texas. She was vice-president of
nieces and nephews.
Pallbearers will be the following nephews and
great-nephews; Harry Bird, Oscar Bird, Wilbur Harris, Ben Harris, Landis
McDaniel, Arthur Wareing, Leslie Wareing, Edgar Wareing, Jr,
Honorary pallbearers will be Judge CL Jester, Dr. EA
Johnson, Judge JM Blanding, officers of the First Presbyterian church and
friends of the family.
Sutherland McCammon Funeral Home, assisted by AW Wareing,
will direct the services.
Jun 18, 1936,
Corsicana Daily Sun
Charles Bank Sutherland
Jan 11, 1858 - Nov 2, 1928
Funeral Services Bank Sutherland Be Held Sunday
Pioneer Resident and Business Man Be Buried in Oakwood
Funeral services for CB Sutherland, aged 70 years, resident
of Corsicana, 64 years, pioneer undertaker, furniture dealer, banker and land
owner, who died at his home 502 North Beaton street, Friday morning shortly
after 8 o'clock, will be held Sunday afternoon at 2:30 o'clock from the First
Presbyterian church with interment in Oakwood
cemetery. The funeral services at
the church will be conducted by Rev. Shepperson, pastor, while the Odd Fellow
will have charge of the services at the grave.
Mr. Sutherland had been ill for some time, his condition
taking a turn for the worse several days ago.
Surviving are his wife; two brothers, G W Sutherland,
Montgomery county; Arthur Sutherland, Corsicana; and other relatives.
A number of prominent funeral directors and high officials
of the IOOF are expected to attend the services.
Mr. Sutherland was the last surviving active charter member
of the Texas State Embalmers and Funeral Directors association was active in the
Lions club and other enterprises.
The deacons of the First Presbyterian church will be active
pallbearers while the Odd Fellows and friends will be honorary pallbearers.
All Lions are requested to meet in a body at the First
Presbyterian Church Sunday afternoon at 2:30 to attend the funeral of our friend
and brother, Lion Sutherland
OM Boynton, President
WJ Rochelle, Secretary
Nov. 3, 1928,
Corsicana Daily Sun
Death Certificate
Charles Bank Sutherland
Great Throng in Attendance Upon Funeral Services
Beloved Corsicana Pioneer, C. B. Sutherland, Laid At Rest
The largest crowd ever to attend a funeral service in
Corsicana, several thousand in number, gathered Sunday afternoon at the First
Presbyterian church and at Oakwood cemetery, to pay their last respects to the
remains of C. B. Southerland, aged 70 years, pioneer funeral director, merchant,
and banker, who had resided in Corsicana for more than sixty years. The funeral
services were conducted by Rev. David Shepperson, pastor of the church, assisted
by Rev. P. Martin Baker, pastor of the Third Avenue Presbyterian church; Rev. H.
J. Ellis, rector of St. John's Episcopal church; Rev. F. P. Culver, pastor of
the First Methodist church, and Rev. C. E. McStravick, pastor of the United
Presbyterian church. At the grave, the Odd Fellows Lodge, of which Mr.
Sutherland was a member for a half century, and holder of many of the highest
offices and honors in the order, had charge of the services. H. J. Emmons of
Dallas, representative of the Sovereign Grand Lodge, spoke of the life of the
departed brother.
Long before the time for the services, the church was
packed to capacity with sorrowing friends and acquaintances, with hundreds
outside and other hundreds preparing to the cemetery to await the funeral
cortege. Many beautiful floral offerings were in evidence, and remembrances and
tributes from people from all over Texas and some from other states were
Interested in Home
Mr. Sutherland was always deeply interested in the IOOF
Home here, being trustee for many years. He held the highest offices in the
local IOOF Lodge No. 63, and also was a member of the Texas Grand Lodge, and
held a number of offices in that organization. He attended the annual meetings
of the Grand Lodge for many years. Many of the inmates of the IOOF Home here,
who have gone from the Home, were present for the funeral and a number of floral
offerings from ex-students of the Home were noted.
Mr. Sutherland was a member of the Corsicana Lions club for
a number of years and was always interested in the work of the club. A large
number of the Lions were present for the services.
Surviving are his wife, two brothers, G. W. Sutherland of
Montgomery county and Arthur Sutherland of Corsicana. G. W. Sutherland had been
here several days. He returned to his home Monday.
Mr. Sutherland was a charter member of the Texas State
Embalmers and Funeral Directors Association, organized at Fort Worth more than
forty years ago.
Of the vast throng gathered for the services, it is safe to
say that very few there who had not at some time had a dear one buried with Mr.
Sutherland in charge.
Funeral Directors Here
Among the funeral directors present were Ed Keever, Ennis,
president of the state organization; T. A. Shellberg, Fort Worth, secretary; D.
T. Lauder, Abilene; F. M. Compton, L. C. Puckett and Tom Tidwell, Waco; George
Nyland, Frank C. Smith, Grant Smith, Bentley Young, George Jennings, Charles
Jennings, George Brewer, Harry Haskings, Harold (Dutch) Graybur, R. F. Woods and
Ernest, C. Davis, all of Dallas; S. P. Spaulding, Waxahachie; W. T. Orr, Ennis;
Tom Wright, Temple; Claude Keever, Ennis; C. B. Cook, Austin; J. M. Beene,
Frost; Tom Bailey, Palestine; C. B. McCormick, Blooming Grove; M. M. Rains,
Marshall and C. M. Nimon, Austin.
Among the visiting Odd Fellows present were J. K. Sasche,
Sasche, Texas; member of the board of trustees of the Home; G. W. Hawkins,
Houston, past grand master of Grand Lodge, and formerly superintendent of the
Home; W. T. Savage, Dallas, past grand master; G. W. Bacus, Wichita Falls; E. Q.
Vestal, Dallas, grand secretary, Mit House, Fort Worth; George Reid, Dallas,
grand lodge trustee; George Knauff, San Antonio, grand lodge trustee; S. P.
Spaulding, Waxahachie, former trustee of the Home, John A. Key, Fort Worth,
grand treasurer; Harry Emmons, Dallas; E. B. Greech, Ennis; Harry Fushbrook,
Temple; S. M. Williams, Dallas, formerly inmate of the Home; Mrs. Johnnie House,
Fort Worth, past president Rebekah Assembly; Mrs. Mae Hatcher James, Dallas,
grand treasurer, Rebekahs; Mrs. Hamilton, Dallas, grand sentinel; Mrs. H. E.
Spaulding, Waxahachie; Mrs. S. P. Spaulding, Waxahachie, and others.
Among the other out of town people were Mr. and Mrs. E. R.
Brown, Dallas; Mr. and Mrs. B. C. Fry, Woodson; Mr. and Mrs. Ivan B. Fry, Ladonia; P. B. Fry, Ladonia; Mr. and Mrs. J. D. Gee and daughter, Mary Jim Gee,
all of Paris; Mrs. E. O. Bird, Paris; W. M. Harris, McCamy; Mrs. Lela Lee and
Uleta Williams, Dallas; Miss Anna Bell, Dallas; Mrs. G. C. Daughtery,
Sweetwarter, Miss Ela Hockaday, Dallas; Miss Edna Washington, Dallas; Mr. and
Mrs., C. M. Crawford, Dallas; Mrs. Eula Swafford, Hillsboro; Mr. and Mrs.
Wallace McFall, Mexia; Mr. and Mrs. Ozie Lewis, Mexia; Mrs. John Davis, Mexia;
Mr. and Mrs. Smith Comfort, Mexia; Mr. and Mrs. H. A. Bridges, Teague; Mrs.
Janie McGilvary, Streetman; Mrs. John Wareing, Dallas; Miss N. Ethel Eagleton,
Arlington; Mrs. Louis Stephens, Mexia and others.
More than 100 children of the IOOF Home were also present.
Nov 5, 1928,
Corsicana Daily Sun
Has Held Position of Sexton for Thirty-Five Years
When the city council re-elected C. B. Sutherland sexton last
Tuesday night it was the thirty-fifth time the council had made this
selection. The late A. Sutherland, Mr. Sutherland's father, was
sexton from the early seventies till 1882, when he was made an
alderman, and the son, C. B. Sutherland succeeded him as sexton in
that year and has held the office continuously since Oakwood
cemetery when the Senior Sutherland was first sexton only embraced
that part of the sacred ground south of the branch which was deeded
to the city by Col. Elliott citizen here, who was the grandfather of
Captain W. J. McKie and it was used for both white and colored
There are quite a number of negro graves near where the fountain now
stands in the northeast corner of the old cemetery plot.
This was in the days before the civil war. That part of the cemetery
north of the branch was bought after the civil war, and was added to
Oakwood as the McPhall field. It was opened as a burial ground in
1876 by Mr. A. Sutherland who was sexton at that time.
Effie Ann Blackmon
d. Sep 27, 1922
Died Here Last Night
Mrs. Effie Ann Blackmon, widow of the late Dillon Blackmon, died at 503 East
Eleventh avenue last night, aged 77 years.
Navarro County TXGenWeb© Copyright
March, 2009
Edward L. Williams & Barbara

subset: commoncrawl


text:
Press Contacts
- Leticia Linn, Tel. 202 974 3440
- Sebastiãn Oliel, Tel. 202 974 3459
- Sonia Mey Schmidt, Tel 202 974 3036
This information is archived and is not being updated.
Health Surveillance and Disease Prevention and Control at PAHO
This fact sheet outlines the mission, focus, and priority areas of the Technical Area for Health Surveillance and Disease Prevention and Control (AD/HSD) of the Pan American Health Organization, as well as links to the four Technical Units and one Regional Pan American Center under its umbrella.
Main Activities
Main Focus
Priority Areas
All HSD Programs have a renewed commitment to disease prevention and recognize the importance of behavior change in this regard. Social communication has therefore become a common interest. The shared agenda with the World Bank and the Inter-American Development Bank includes the development of surveillance capacity in the countries for both communicable and noncommunicable diseases.
Units and Centers
The Area of Health Surveillance and Disease Management carries out it mandate through four Technical Units and two Pan American Centers:
Each Technical Unit is headed by a Unit Chief and encompasses a variety of Regional Programs headed by a Regional Advisor.


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