Comprehensive care: building community alliances for care of people with HIV/AIDS

In this article we suggest that optimal care for people livingwith HIV/AIDS calls for a multidisciplinary and multisectoralapproach, which can be achieved with cooperation between thestatutory and non-statutory service systems. AIDS has both directlyand indirectly focused attention on the limitations of the servicesavailable in our communities, including those provided by theprimary and secondary health sector. However, non-statutorycommunity-based organizations have been providing vital servicesof information, counselling and care, relying on a steady streamof unpaid labour. Community control over its health care systemand environment should be encouraged and local authorities shouldacknowledge the resources provided by non-statutory bodies,supporting such groups both morally and financially. Using theHealthy Cities project network as a framework, we recommendestablishing working relationships to enhance service integration.The creation of service alliances is intended to facilitatecontinuity of care by establishing links within local governmentagencies, and the priority of the alliance should be to developa realistic, comprehensive service plan involving all interestedparties.     

Interleukin-4 and Interferon-γ: The Quintessence of a Mutual Antagonistic Relationship

The two cytokines interleukin (IL)-4 and interferon (IFN)-γ play major roles in the generation and regulation of immune responses. Central in this respect is their mutually antagonistic functions. First, IL-4 promotes T helper cell type 2 (Th2) differentiation and stability and inhibits Th1-cell differentiation. A direct role of IFN-γ in Th1-cell differentiation is debatable, whereas inhibition of Th2-cell differentiation and roles in Th1-cell stabilization are well established functions of IFN-γ. Secondly, IL-4 and IFN-γ also affect antibody class switch and expression of Fc receptors differentially, which strongly affect the effector mechanisms following antibody production. Thirdly, macrophage activities induced or enhanced by IFN-γ, such as expression of certain cytokines, surface molecules and enzymes, are antagonized by IL-4. Together, these functions of IL-4 and IFN-γ place the two cytokines at cardinal positions in the regulation of immune reactions. In this review the known molecular mechanisms underlying the observed functions of IL-4 and IFN-γ are presented and discussed.