Academic literature on the topic 'Virus à transmission verticale'

I hope that this Vertical Transmission finds you and your families, friends and colleagues safe and well. Across Australia, we continue to deal with the COVID-19 pandemic, mostly through the restrictions that have been imposed to prevent transmission of the virus. Thankfully these measures have been highly effective and we have not seen the high case numbers and deaths that we see reported daily in other countries.

Background Zika virus (ZIKV) is an arthropod-borne flavivirus transmitted by Aedes mosquitoes. Aedes albopictus is an important vector of ZIKV worldwide. To date, most experiments have focused on the vertical transmission of ZIKV in Ae. aegypti, while studies on Ae. albopictus are very limited. To explore vertical transmission in Ae. albopictus, a series of laboratory studies were carried out. Methodology/Principal findings In this study, Ae. albopictus were blood-fed with ZIKV-infectious blood, and the ovaries and offspring viral infection rates were analyzed by reverse transcription PCR (RT-PCR), real-time reverse transcription PCR (RT-qPCR) and immunohistochemistry (IHC). ZIKV was detected in the ovaries and oviposited eggs in two gonotrophic cycles. The minimum filial egg infection rates in two gonotrophic cycles were 2.06% and 0.69%, and the effective population transmission rate was 1.87%. The hatching, pupation, and emergence rates of infected offspring were not significantly different from those of uninfected offspring, indicating that ZIKV did not prevent the offspring from completing the growth and development process. ZIKV was detected in three of thirteen C57BL/6 suckling mice bitten by ZIKV-positive F1 females, and the viremia persisted for at least seven days. Conclusions/Significance ZIKV can be vertically transmitted in Ae. albopictus via transovarial transmission. The vertical transmission rates in F1 eggs and adults were 2.06% and 1.87%, respectively. Even though the vertical transmission rates were low, the female mosquitoes infected via the congenital route horizontally transmitted ZIKV to suckling mice through bloodsucking. This is the first experimental evidence of offspring with vertically transmitted ZIKV initiating new horizontal transmission. The present study deepens the understanding of the vertical transmission of flaviviruses in Aedes mosquitoes and sheds light on the prevention and control of mosquito-borne diseases.

Abstract West Nile virus (family Flaviviridae, genus Flavivirus) first caused human and veterinary disease, and was isolated from Culex pipiens pipiens L. and Aedes vexans (Meigen) (Diptera: Culicidae) in the United States in 1999. We report that a Connecticut strain of Ae. vexans was competent to transmit West Nile virus both horizontally to suckling mice and vertically to its progeny in the laboratory. Horizontal transmission was first observed on day 6 post-exposure (pe). Daily horizontal transmission rates generally increased with the day post-virus exposure with highest rates of 67–100% recorded on days 28–30 pe. One female vertically transmitted West Nile virus on day 21 pe, but only after it had taken its third bloodmeal. Horizontal and vertical transmission may contribute to West Nile virus infection rates in Ae. vexans in summer, and vertical transmission provides a means of survival of West Nile virus during winter.

Le virus de l'immunodéficience humaine (VIH) est caractérisé par une grande diversité génétique. Deux types de virus ont été identifiés : les VIH-1 et 2. Au Burkina Faso, pays où se situe notre étude, aucune description de la diversité des souches circulantes n'a été entreprise. Nos objectifs étaient d'évaluer l'influence des sous-types du VIH-1 sur le sérodiagnostic de l'infection et sur la transmission du virus de la mère à l'enfant. Les outils utilisés pour décrypter la diversité du VIH-1 étaient un test de sérotypage par compétition de peptides en phase liquide et la technique génétique de mobilité des hétéroduplexes (HMA). Une évaluation de tests commerciaux de sérodiagnostic de l'infection par le VIH a été réalisée au Burkina Faso afin de proposer une stratégie nationale simple, fiable et peu onéreuse. Le sérotypage des échantillons positifs aux tests ELISA évalués dans cette étude a montré que les réponses en densité optique aux tests ELISA étaient très élevées quel que soit le sérotype du VIH infectant. Une surveillance répétée de la fiabilité des tests utilisés en fonction de l'introduction des nouvelles souches de VIH a été recommandée. Un essai clinique évaluant la tolérance à la zidovudine et au chlorure de benzalkonium chez des femmes enceintes infectées par le VIH-1, a été réalisé. Des souches de génotype A et G ont été identifiées par HMA. Ces résultats suggèrent que la technique de sérotypage utilisée n'est pas un outil contributif pour le sous-typage du VIH-1 au Burkina Faso. Les résultats du suivi biologique des mères et de leurs enfants ont montré que les génotypes A et G ne sont pas des déterminants de la transmission verticale du VIH-1, d'un taux bas de lymphocytes CD4 maternels, ni d'une charge virale maternelle élevée. La réalisation de ce type d'étude dans des pays où d'autres sous-types sont prédominants a été recommandée, afin d'avoir une vision plus large de l'influence des sous-types du VIH-1 sur la transmission verticale du virus.

La grossesse réussie implique une adaptation du système immunitaire maternel à la présence du fœtus, qui peut être considéré, au niveau immunologique, comme une semi-allogreffe. La tolérance de la mère nécessite une immunosuppression locale, à laquelle participe fortement le réseau cytokinique placentaire et utérin. Nous avons étudié les cytokines et chimiokines présentes à l'interface placentaire du premier trimestre et de fin de grossesse humaine. Les composants majoritaire de l’environnement cytokinique placentaire sont, dans notre système d'étude, les chimiokines MIP-lα, MIP-1,1β, RANTES et IL-8, ainsi que les cytokines inflammatoires IL-lβ, IL-6 et TNF-α, et que les facteurs de croissance GM-CSF et CSF-1. Par contre, contrairement à l'hypothèse avancée en 1993, que la grossesse réussie nécessitait un profil de cytokines locales de type 2, nous n'avons pas mis en évidence de sécrétion significative de ces cytokines par les villosités placentaires. Des différences quantitatives existent entre les cytokines produites par le placenta du premier trimestre et le placenta de fin de grossesse, qui pourraient correspondre à des modifications des fonctions métaboliques, hormonales et invasives du placenta. La transmission materno-fœtale du VIH peut avoir lieu in utero et impliquer le passage du virus à travers la barrière placentaire. Pensant que le microenvironnement placentaire pouvait jouer un rôle régulateur de ce passage, nous avons comparé les profils d’expression des différentés cytokines et chimiokines entre les villosités placentaires de mères séropositives pour le Vlll et de mères séronégatives. Nous n'avons pas pu mettre en évidence de différence significative majeure dans la production des cytokines locales entre ces deux types de placentas. Cependant, la population trophoblastique, constituant la première couche cellulaire du placenta en contact avec le sang maternei, pourrait être capable de moduler ses sécrétions de cytokines inflammatoires et de chimiokines sous l'action du virus. Nous en concluons que des variations fines et locales pourraient entrer en jeu dans des processus autocrines impliquant les trophoblastes, et modulant peut-être leurs capacités invasives, métaboliques, ainsi que la réplication virale si ils sont infectés in vivo et la transmission du virus aux couches cellulaires placentaires plus internes
Pregnancy outcome is depending on the capacity of aptation of the maternal immune system to the presence of the semi-allogeneic fetus. Maternal tolerance is mediated, by part, by a local immunosuppression. Placental cytokines and microenvironment are essential components of this tolerance. We have studied the cytokines and chemokines spontaneously secreted by human placental villi and cells, from first trimester or end _of pregnancy. We found expression of chemokines (MIP- Lα. , MIP-lβ, RANTES and IL-8), inflammatory ;cytokines (lL-I β, IL-6 and TNF-α. ), and growth factors (GM­ CSF and CSF-1). Surprising!y, we did not detect important secretion of any type 1 or type 2 cytokines. We could highlighted quantitative differences in the pattern of cytokines and chemokines expression between first trimester and term placentae, which could be related to variations in metabolic, hormonal and invasive functions. Mother-to-child HIV-1 transmission could occur in utero through the placental barrier. We hypothesized that placental microenvironment could influence mechanisms of placental viral transmission, and we compared cytokines and chemokines secretion profiles between term placentae from HIV-seropositive and HIV-seronegativewomen. No major difference could be seen at the level of placental tissue. However, it seems that the first cellular layer in contact with maternal blood (trophoblatic cells) may express differently intlammatory cytokines and chemokines depending on the HIV infection of the mother. Some local variations in cytokines and chemokines may act in an autocrine proccss on proliferative, invasive and hormonal functions of trophoblast, or on HIV replication and spreading in the placenta, if trophoblasts are infected in vivo

Vertical transmission of human immunodeficiency virus type 1 (HIV-1) occurs at an estimated rate of 30% and accounts for 90% of all HIV-1 infections in children. Increased risk of vertical transmission correlates with advanced maternal disease status, low CD4+ lymphocyte count, and high viral load. However, the molecular mechanisms of vertical transmission are poorly understood, making it difficult to design effective strategies for prevention and treatment. Our hypothesis is that specific molecular and biological properties of HIV-1 are critical determinants of vertical transmission. We characterized the HIV-1 gag p17 matrix (MA) and nef genes associated with and without vertical transmission. In addition, we determined the effect of env gp120 from mother-infant pairs and from infected mothers who failed to transmit the virus to their infants (non-transmitting mothers) on HIV-1 replication, cellular tropism, cytopathic effects and co-receptor utilization. Our data indicate that the open reading frames and the functional domains of both the gag p17MA and nef genes were highly conserved in isolates from mothers and their infants. While there was no significant difference in the maintenance of open reading frames and the conservation of functional domains between isolates from transmitting and non-transmitting mothers, we found that the non-transmitting mothers' gag p17MA sequences were more homogenous compared with the transmitting mothers' sequences. In addition, we were able to associate several motifs in p17MA with either transmitting or non-transmitting status. To study the effect of gp120 on HIV-1 biology, we reciprocal inserted the gp120 from mother-infant pairs and non-transmitting mothers into a T-tropic infectious clone and found that the chimeras were unable to replicate in T-cell lines and did not form syncytia in MT-2 cells. Moreover, these chimeras used the CCR5 co-receptor for entry in the U373MAGI-CD4-CCR5 cell line. Both the mother-infant pairs' and the non-transmitting mothers' gp120 chimeras replicated well in primary peripheral blood lymphocytes (PBL) with no significant difference in replication kinetics. These results may be helpful in the understanding of the association of viral determinants and molecular mechanisms of vertical transmission, which may contribute towards the development of new strategies for treatment and prevention of HIV-1 infection in children.

LA TRANSMISSION MERE-ENFANT (TME) EST RESPONSABLE DE PLUS DE 90% DU NOMBRE D'ENFANTS INFECTES PAR LE VIH-1. LES ANTIRETROVIRAUX (ARV) ONT PERMIS DE REDUIRE EFFICACEMENT LA TME DU VIH-1 DANS LES PAYS DEVELOPPES. AVANT L'AN 2000, IL N'Y AVAIT PAS DE PROGRAMME DE PREVENTION DE LA TME DU VIH-1 AU CAMEROUN. LES OBJECTIFS PRINCIPAUX DE CETTE THESE ETAIENT DE CONTRIBUER A LA MISE EN PLACE D'UN PROGRAMME DE PREVENTION DE LA TME DU VIH-1 AU CAMEROUN EN UTILISANT LA NEVIRAPINE (NVP) ET D'ETUDIER DES FACTEURS ASSOCIES AU CONTROLE OU NON DE LA TME COMME L'ENVIRONNEMENT CYTOKINIQUE DU PLACENTA ET LES CONFECTIONS PALUSTRES. NOS RESULTATS INDIQUENT QUE LE TAUX DE TME DU VIH-1 AVEC LA NVP ETAIT DE 13% ET CECI DANS UN CONTEXTE DE FORTE DIVERSITE VIRALE ET DE FAIBLE RESISTANCE INITIALE DU VIH-1 AUX ARV (MOINS DE 5%). UNE VARIABILITE IMPORTANTE DES NIVEAUX DE CYTOKINES (ARNM ET SECRETION) ETAIT OBSERVEE DANS LES PLACENTAS DES FEMMES VIH-1 NEGATIVES ET POSITIVES. LORSQUE LES PARAMETRES CLINIQUES ETAIENT PRIS EN CONSIDERATION, DES DIFFERENCES SIGNIFICATIVES ETAIENT OBSERVEES ENTRE LES FEMMES VIH-1 NEGATIVES ET POSITIVES AVEC UNE PREDOMINANCE DU TNF-oc CHEZ LES POSITIVES. LA PARASITEMIE PALUSTRE ETAIT PLUS ELEVEE CHEZ LES FEMMES VIH-1 POSITIVES. NOS RESULTATS INDIQUENT EGALEMENT QUE LE PALUDISME MODULAIT L'ENVIRONNEMENT CYTOKINIQUE PLACENTAIRE. NOUS AVONS MONTRE EN PARALLELE QUE LE TNF-a, QUI EST ELEVE LORS DU PALUDISME, AUGMENTE LA REPLICATION VIRALE DANS DES HISTOCULTURES DE PLACENTAS INFECTES PAR LE VIH-1. CES RESULTATS CONFIRMENT L'EFFICACITE DE LA NVP POUR REDUIRE LA TME DU VIH-1. CEPENDANT LE PALUDISME POURRAIT DIMINUER CETTE EFFICACITE EN MODIFIANT LES PROFILS DE CYTOKINES PLACENTAIRES
More than 90% of hiv-1 infected children acquire the virus through mother-to-child transmission (mtct). Antiretroviral (arv) prophylaxis have greatly reduced mtct of hiv-1 in the developed world. Before 2000, no effective program on the prevention of mtct existed in cameroun. The main objectives of this thesis were to contribute in the initiation of a program on the prevention of hiv-1 mtct in cameroun using nevirapine (nvp) and to study factors associated with the control or not of mtct such as the placental cytokine profiles and malaria confections. We observed a 13% mtct of hiv-1 with nvp prophylaxis in a context of a large hiv-1 diversity in yaounde. Less than 5% of the pregnant women naïve of arv treatment presented resistant mutations to arv. A high variability was observed in the mrna expression and secretion of cytokines in the placentas of both hiv-1 negative and positive women. Analyses considering clinical parameters revealed significant differences between hiv-1 negative and positive women, with tnf-a predominating in the hiv-1 positive group. Malaria parasitemia was significantly higher among hiv-1 positive women. Malaria parasite was observed to greatly alter the placenta cytokine environment. We then showed in parallel that tnf-a, which is associated with malaria, enhanced viral replication on hiv-1 infected placental histocultures. Together, these results show that nvp is efficient in the prevention of hiv-1 mtct and that malaria could alter this efficiency by modulating the placental cytokine environment

Orientador: Helaine Maria Besteli Pires Milanez
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas
Made available in DSpace on 2018-08-14T07:08:24Z (GMT). No. of bitstreams: 1 Delicio_AdrianeMaira.pdf: 1826833 bytes, checksum: bc3f2dce3447c00fccb97f45337d0f78 (MD5) Previous issue date: 2009
Resumo: Objetivo: avaliar a transmissão vertical (TV) do HIV e fatores associados em gestantes soropositivas acompanhadas em um serviço universitário brasileiro (CAISM/UNICAMP) entre 2000 e 2009. Sujeitos e Métodos: coorte histórica de 452 gestações e seus recém-nascidos. Os dados foram coletados dos prontuários e registrados em fichas específicas. Crianças sem seguimento foram convocadas para definição diagnóstica. Análise dos dados: análise descritiva através de distribuição percentual e de médias; teste de X², exato de Fisher, t de Student, Mann-Whitney e ANOVA, razão de risco e intervalo de confiança. Resultados: A TV foi de 3,6%. A idade média das gestantes foi 27 anos; principal categoria de exposição foi a sexual (86,5%); 55% já apresentava o diagnóstico prévio à gravidez. Sessenta e dois por cento não estavam em uso de TARV ao engravidar. CD4 médio inicial foi de 474 células/ml e 70.3% apresentaram carga viral indetectável no terceiro trimestre. Como TARV, 55% usaram esquemas com IP e 35% com nevirapina. Monoterapia com AZT foi utilizada em 5,5%. Idade gestacional média no parto foi de 37,2 semanas e em 92% a via foi cesárea; 97,2% receberam AZT endovenoso. Os fatores associados à TV foram: baixa contagem de CD4, elevada carga viral, tempo reduzido de TARV, presença de alterações gestacionais (anemia, RCF, oligoâmnio), coinfecções durante o pré-natal (CMV e toxoplasmose) e presença de trabalho de parto. Uso de TARV potente, parto por cesárea e uso do AZT pelo RN foram fatores protetores. Má adesão ao tratamento esteve presente em 13 dos 15 casos infectados; em sete houve presença de coinfecção neonatal (CMV e toxoplasmose). Conclusão: Fatores de risco para TV foram comprometimento do estado imunológico da gestante, menor tempo de terapia, coinfecções (CMV e toxoplasmose) e presença de trabalho de parto. O uso de TARV potente e a realização de cesárea foram fatores protetores para a TV do HIV.
Abstract: Objectives: to evaluate mother-to-child transmission (MTCT) rates and related factors in HIV-infected pregnant women from CAISM/UNICAMP between 2000 and 2009. Subjects and methods: cohort of 452 HIV-infected pregnant women and their newborns. Data was collected from recorded files and undiagnosed children were enrolled for investigation. Statistical analysis: qui-square test, Fisher exact test, Student t test, Mann-Whitney test, ANOVA, risk ratio and confidence intervals. Results: MTCT occurred in 3.6%. The study population displayed a mean age of 27 years; 86.5% were found to have acquired HIV through sexual contact; 55% were aware of the diagnosis prior to the pregnancy; 62% were not using HAART. Mean CD4 cell-count was 474 cells/ml and 70.3% had undetectable viral loads in the third trimester. HAART included nevirapine in 35% of cases and protease inhibitors in 55%; Zidovudine monotherapy was used in 5.5%. Mean gestational age at delivery was 37.2 weeks and in 92% by caesarian section; 97.2% received intravenous zidovudine. Implicated factors related to MTCT were: low CD4 cell counts, elevated viral loads, maternal aids, shorter periods receiving HAART, maternal concurring illnesses (anemia, IUGR, oligodydramnium), coinfections (CMV and toxoplasmosis) and the occurrence of labor. Use of HAART for longer periods, caesarian delivery and oral zidovudine for the newborns were associated with a decreased risk. Poor adhesion to treatment was present in 13 of the 15 cases of transmission; in 7, co-infections were diagnosed (CMV and toxoplasmosis). Conclusion: Use of HAART and caesarian delivery are protective factors in mother-to-child transmission of HIV. Maternal coinfecctions and maternal concurring illnesses were risk factors for MTCT.
Universidade Estadual de Campi
Ciencias Biomedicas
Mestre em Tocoginecologia

Thèse de doctorat : Sciences de la vie et de la santé : Tours : 2008. Thèse de doctorat : Sciences de la vie et de la santé : CHIANG MAI UNIVERSITY : 2008.
Thèse soutenue en co-tutelle. Titre provenant de l'écran-titre.

Une meilleure compréhension de l'immunité innée et muqueuse est nécessaire pour la mise en place d'un futur vaccin protecteur contre le VIH-1. La muqueuse utérine pendant la grossesse (la décidua) apparaît comme un modèle pertinent de protection puisque la transmission mère-enfant du VIH-1 est rare in utero surtout pendant le premier trimestre de grossesse. Les objectifs de ce travail de thèse étaient de mettre en place un modèle d'étude de la décidua humaine afin d'étudier l'infection VIH-1 et d'identifier les mécanismes de contrôle pouvant être présent au sein de ce tissu. Au cours de cette thèse, nous avons mis en place et validé un modèle d'étude du tissu décidual humain à partir de produits d'IVG réalisées au premier trimestre. Nous avons montré que la décidua était permissive à l'infection in vitro par le VIH-1 et préférentiellement par les virus de tropisme R5. Les principales cibles du virus ont été caractérisées : il s'agit des cellules présentatrices d'antigène qui partagent des propriétés des macrophages M2 et des cellules dendritiques tolérogéniques. Le microenvironnement présent dans la décidua participe au contrôle de la dissémination virale notamment via la production de beta-chimiokines par les cellules immunes de la décidua. Nous avons également démontré une dynamique d'expression du phénotype des cellules NK de la décidua au cours du premier trimestre. Ces cellules pourraient être impliquées dans le contrôle de la dissémination du VIH-1 à l'interface materno-fœtale. La caractérisation des mécanismes de contrôle donnera des éléments d'informations pour l'élaboration de nouvelles stratégies vaccinales protectrices contre le VIH-1
A better understanding of the innate and mucosal immunity is needed for the design of a protective vaccine against HIV-1. The uterine mucosa during pregnancy (the decidua) is a relevant model of protection since in utero mother-to-child transmission of HIV-1 is rarely observed, particularly during the first trimester of pregnancy. The objectives of this PhD study were to develop a study model of human decidua to characterize HIV-1 infection, and to identify the potential mechanisms of viral control within this tissue. During this PhD, we have set up and validated an in vitro and ex vivo model to study the decidual mucosa obtained from voluntary pregnancy termination samples during the first trimester. We demonstrated that the decidua was permissive to in vitro HIV-1 infection and mostly by the R5 virus. The target cells were characterized: they are antigen presenting cells which share the phenotype of M2 macrophages as well as of tolerogenic dendritic cells. The microenvironement of the decidua participates in the control of viral dissémination especially through the production of beta- chemokines by decidual immune cells. We also showed that in vivo the decidual NK cell phenotype changes over time. These effector cells could potentially participate in the control of HIV-1 dissemination within the materno-fetal interface. The characterization of the control mechanisms will give new pieces of information relevant for the design of new strategies to develop a protective vaccine against HIV-1

The Transfusion Safety Study is collecting data concerning the transmission of transfusion-acquired infections from patients with congenital hematologic disorders to household members. Of 233 patients for whom information is presently available, 128 (55%) were anti-HIV-positive. The 128 positive patients lived in 123 households with 174 members; 16 contacts were positive by EIA and immunoblot.These data provide further evidence of relatively high risk of HIV infection of sexual contacts. The three anti-HIV-positive children are all infants born to anti-HIV-positive wivesof infected hemophiliacs. Passively acquired antibody has not been excluded for two; the third was positive at ten months of age. Thus, vertical transmission may be a very important mechanism of perpetuating the HIV reservoir.

1.1 Macroeconomic summary Economic recovery has consistently outperformed the technical staff’s expectations following a steep decline in activity in the second quarter of 2020. At the same time, total and core inflation rates have fallen and remain at low levels, suggesting that a significant element of the reactivation of Colombia’s economy has been related to recovery in potential GDP. This would support the technical staff’s diagnosis of weak aggregate demand and ample excess capacity. The most recently available data on 2020 growth suggests a contraction in economic activity of 6.8%, lower than estimates from January’s Monetary Policy Report (-7.2%). High-frequency indicators suggest that economic performance was significantly more dynamic than expected in January, despite mobility restrictions and quarantine measures. This has also come amid declines in total and core inflation, the latter of which was below January projections if controlling for certain relative price changes. This suggests that the unexpected strength of recent growth contains elements of demand, and that excess capacity, while significant, could be lower than previously estimated. Nevertheless, uncertainty over the measurement of excess capacity continues to be unusually high and marked both by variations in the way different economic sectors and spending components have been affected by the pandemic, and by uneven price behavior. The size of excess capacity, and in particular the evolution of the pandemic in forthcoming quarters, constitute substantial risks to the macroeconomic forecast presented in this report. Despite the unexpected strength of the recovery, the technical staff continues to project ample excess capacity that is expected to remain on the forecast horizon, alongside core inflation that will likely remain below the target. Domestic demand remains below 2019 levels amid unusually significant uncertainty over the size of excess capacity in the economy. High national unemployment (14.6% for February 2021) reflects a loose labor market, while observed total and core inflation continue to be below 2%. Inflationary pressures from the exchange rate are expected to continue to be low, with relatively little pass-through on inflation. This would be compatible with a negative output gap. Excess productive capacity and the expectation of core inflation below the 3% target on the forecast horizon provide a basis for an expansive monetary policy posture. The technical staff’s assessment of certain shocks and their expected effects on the economy, as well as the presence of several sources of uncertainty and related assumptions about their potential macroeconomic impacts, remain a feature of this report. The coronavirus pandemic, in particular, continues to affect the public health environment, and the reopening of Colombia’s economy remains incomplete. The technical staff’s assessment is that the COVID-19 shock has affected both aggregate demand and supply, but that the impact on demand has been deeper and more persistent. Given this persistence, the central forecast accounts for a gradual tightening of the output gap in the absence of new waves of contagion, and as vaccination campaigns progress. The central forecast continues to include an expected increase of total and core inflation rates in the second quarter of 2021, alongside the lapse of the temporary price relief measures put in place in 2020. Additional COVID-19 outbreaks (of uncertain duration and intensity) represent a significant risk factor that could affect these projections. Additionally, the forecast continues to include an upward trend in sovereign risk premiums, reflected by higher levels of public debt that in the wake of the pandemic are likely to persist on the forecast horizon, even in the context of a fiscal adjustment. At the same time, the projection accounts for the shortterm effects on private domestic demand from a fiscal adjustment along the lines of the one currently being proposed by the national government. This would be compatible with a gradual recovery of private domestic demand in 2022. The size and characteristics of the fiscal adjustment that is ultimately implemented, as well as the corresponding market response, represent another source of forecast uncertainty. Newly available information offers evidence of the potential for significant changes to the macroeconomic scenario, though without altering the general diagnosis described above. The most recent data on inflation, growth, fiscal policy, and international financial conditions suggests a more dynamic economy than previously expected. However, a third wave of the pandemic has delayed the re-opening of Colombia’s economy and brought with it a deceleration in economic activity. Detailed descriptions of these considerations and subsequent changes to the macroeconomic forecast are presented below. The expected annual decline in GDP (-0.3%) in the first quarter of 2021 appears to have been less pronounced than projected in January (-4.8%). Partial closures in January to address a second wave of COVID-19 appear to have had a less significant negative impact on the economy than previously estimated. This is reflected in figures related to mobility, energy demand, industry and retail sales, foreign trade, commercial transactions from selected banks, and the national statistics agency’s (DANE) economic tracking indicator (ISE). Output is now expected to have declined annually in the first quarter by 0.3%. Private consumption likely continued to recover, registering levels somewhat above those from the previous year, while public consumption likely increased significantly. While a recovery in investment in both housing and in other buildings and structures is expected, overall investment levels in this case likely continued to be low, and gross fixed capital formation is expected to continue to show significant annual declines. Imports likely recovered to again outpace exports, though both are expected to register significant annual declines. Economic activity that outpaced projections, an increase in oil prices and other export products, and an expected increase in public spending this year account for the upward revision to the 2021 growth forecast (from 4.6% with a range between 2% and 6% in January, to 6.0% with a range between 3% and 7% in April). As a result, the output gap is expected to be smaller and to tighten more rapidly than projected in the previous report, though it is still expected to remain in negative territory on the forecast horizon. Wide forecast intervals reflect the fact that the future evolution of the COVID-19 pandemic remains a significant source of uncertainty on these projections. The delay in the recovery of economic activity as a result of the resurgence of COVID-19 in the first quarter appears to have been less significant than projected in the January report. The central forecast scenario expects this improved performance to continue in 2021 alongside increased consumer and business confidence. Low real interest rates and an active credit supply would also support this dynamic, and the overall conditions would be expected to spur a recovery in consumption and investment. Increased growth in public spending and public works based on the national government’s spending plan (Plan Financiero del Gobierno) are other factors to consider. Additionally, an expected recovery in global demand and higher projected prices for oil and coffee would further contribute to improved external revenues and would favor investment, in particular in the oil sector. Given the above, the technical staff’s 2021 growth forecast has been revised upward from 4.6% in January (range from 2% to 6%) to 6.0% in April (range from 3% to 7%). These projections account for the potential for the third wave of COVID-19 to have a larger and more persistent effect on the economy than the previous wave, while also supposing that there will not be any additional significant waves of the pandemic and that mobility restrictions will be relaxed as a result. Economic growth in 2022 is expected to be 3%, with a range between 1% and 5%. This figure would be lower than projected in the January report (3.6% with a range between 2% and 6%), due to a higher base of comparison given the upward revision to expected GDP in 2021. This forecast also takes into account the likely effects on private demand of a fiscal adjustment of the size currently being proposed by the national government, and which would come into effect in 2022. Excess in productive capacity is now expected to be lower than estimated in January but continues to be significant and affected by high levels of uncertainty, as reflected in the wide forecast intervals. The possibility of new waves of the virus (of uncertain intensity and duration) represents a significant downward risk to projected GDP growth, and is signaled by the lower limits of the ranges provided in this report. Inflation (1.51%) and inflation excluding food and regulated items (0.94%) declined in March compared to December, continuing below the 3% target. The decline in inflation in this period was below projections, explained in large part by unanticipated increases in the costs of certain foods (3.92%) and regulated items (1.52%). An increase in international food and shipping prices, increased foreign demand for beef, and specific upward pressures on perishable food supplies appear to explain a lower-than-expected deceleration in the consumer price index (CPI) for foods. An unexpected increase in regulated items prices came amid unanticipated increases in international fuel prices, on some utilities rates, and for regulated education prices. The decline in annual inflation excluding food and regulated items between December and March was in line with projections from January, though this included downward pressure from a significant reduction in telecommunications rates due to the imminent entry of a new operator. When controlling for the effects of this relative price change, inflation excluding food and regulated items exceeds levels forecast in the previous report. Within this indicator of core inflation, the CPI for goods (1.05%) accelerated due to a reversion of the effects of the VAT-free day in November, which was largely accounted for in February, and possibly by the transmission of a recent depreciation of the peso on domestic prices for certain items (electric and household appliances). For their part, services prices decelerated and showed the lowest rate of annual growth (0.89%) among the large consumer baskets in the CPI. Within the services basket, the annual change in rental prices continued to decline, while those services that continue to experience the most significant restrictions on returning to normal operations (tourism, cinemas, nightlife, etc.) continued to register significant price declines. As previously mentioned, telephone rates also fell significantly due to increased competition in the market. Total inflation is expected to continue to be affected by ample excesses in productive capacity for the remainder of 2021 and 2022, though less so than projected in January. As a result, convergence to the inflation target is now expected to be somewhat faster than estimated in the previous report, assuming the absence of significant additional outbreaks of COVID-19. The technical staff’s year-end inflation projections for 2021 and 2022 have increased, suggesting figures around 3% due largely to variation in food and regulated items prices. The projection for inflation excluding food and regulated items also increased, but remains below 3%. Price relief measures on indirect taxes implemented in 2020 are expected to lapse in the second quarter of 2021, generating a one-off effect on prices and temporarily affecting inflation excluding food and regulated items. However, indexation to low levels of past inflation, weak demand, and ample excess productive capacity are expected to keep core inflation below the target, near 2.3% at the end of 2021 (previously 2.1%). The reversion in 2021 of the effects of some price relief measures on utility rates from 2020 should lead to an increase in the CPI for regulated items in the second half of this year. Annual price changes are now expected to be higher than estimated in the January report due to an increased expected path for fuel prices and unanticipated increases in regulated education prices. The projection for the CPI for foods has increased compared to the previous report, taking into account certain factors that were not anticipated in January (a less favorable agricultural cycle, increased pressure from international prices, and transport costs). Given the above, year-end annual inflation for 2021 and 2022 is now expected to be 3% and 2.8%, respectively, which would be above projections from January (2.3% and 2,7%). For its part, expected inflation based on analyst surveys suggests year-end inflation in 2021 and 2022 of 2.8% and 3.1%, respectively. There remains significant uncertainty surrounding the inflation forecasts included in this report due to several factors: 1) the evolution of the pandemic; 2) the difficulty in evaluating the size and persistence of excess productive capacity; 3) the timing and manner in which price relief measures will lapse; and 4) the future behavior of food prices. Projected 2021 growth in foreign demand (4.4% to 5.2%) and the supposed average oil price (USD 53 to USD 61 per Brent benchmark barrel) were both revised upward. An increase in long-term international interest rates has been reflected in a depreciation of the peso and could result in relatively tighter external financial conditions for emerging market economies, including Colombia. Average growth among Colombia’s trade partners was greater than expected in the fourth quarter of 2020. This, together with a sizable fiscal stimulus approved in the United States and the onset of a massive global vaccination campaign, largely explains the projected increase in foreign demand growth in 2021. The resilience of the goods market in the face of global crisis and an expected normalization in international trade are additional factors. These considerations and the expected continuation of a gradual reduction of mobility restrictions abroad suggest that Colombia’s trade partners could grow on average by 5.2% in 2021 and around 3.4% in 2022. The improved prospects for global economic growth have led to an increase in current and expected oil prices. Production interruptions due to a heavy winter, reduced inventories, and increased supply restrictions instituted by producing countries have also contributed to the increase. Meanwhile, market forecasts and recent Federal Reserve pronouncements suggest that the benchmark interest rate in the U.S. will remain stable for the next two years. Nevertheless, a significant increase in public spending in the country has fostered expectations for greater growth and inflation, as well as increased uncertainty over the moment in which a normalization of monetary policy might begin. This has been reflected in an increase in long-term interest rates. In this context, emerging market economies in the region, including Colombia, have registered increases in sovereign risk premiums and long-term domestic interest rates, and a depreciation of local currencies against the dollar. Recent outbreaks of COVID-19 in several of these economies; limits on vaccine supply and the slow pace of immunization campaigns in some countries; a significant increase in public debt; and tensions between the United States and China, among other factors, all add to a high level of uncertainty surrounding interest rate spreads, external financing conditions, and the future performance of risk premiums. The impact that this environment could have on the exchange rate and on domestic financing conditions represent risks to the macroeconomic and monetary policy forecasts. Domestic financial conditions continue to favor recovery in economic activity. The transmission of reductions to the policy interest rate on credit rates has been significant. The banking portfolio continues to recover amid circumstances that have affected both the supply and demand for loans, and in which some credit risks have materialized. Preferential and ordinary commercial interest rates have fallen to a similar degree as the benchmark interest rate. As is generally the case, this transmission has come at a slower pace for consumer credit rates, and has been further delayed in the case of mortgage rates. Commercial credit levels stabilized above pre-pandemic levels in March, following an increase resulting from significant liquidity requirements for businesses in the second quarter of 2020. The consumer credit portfolio continued to recover and has now surpassed February 2020 levels, though overall growth in the portfolio remains low. At the same time, portfolio projections and default indicators have increased, and credit establishment earnings have come down. Despite this, credit disbursements continue to recover and solvency indicators remain well above regulatory minimums. 1.2 Monetary policy decision In its meetings in March and April the BDBR left the benchmark interest rate unchanged at 1.75%.