I welcome the Minister of State. I am sorry the Minister for Health and Children is not here himself because this is a very important topic.
This week the Minister has been dealing publicly and in the other House with the possible transmission of infection by a blood product. While the possibility of the infectious agent which causes CJD being passed on in this way is most remote, I want to ask the Minister to deal urgently with another matter — the transmission of HIV infection from mother to unborn child. If the Department of Health and Children does not deal with this now, there is a definite possibility of successful litigation by children who are so infected.
While there have been major advances in the past few years in the treatment of HIV infection, it still remains an incurable and ultimately lethal condition. Testing for the presence of HIV infection is voluntary, but in view of the fact that early treatment gives better results people are becoming less reluctant to undergo testing. For one group of those infected with HIV, testing is of extreme importance, that group consists of infected children.
Speaking at the Foundation Day meeting at Crumlin Children's Hospital recently, my colleague, Dr. Karina Butler, who is a consultant in paediatrics and paediatric infectious diseases, discussed the need for antenatal testing of pregnant women for HIV infection.
About 7 per cent of all persons who test positive for HIV infection in this country are children and nearly 100 per cent of these test positive because of infection in their mothers. There is a vertical transmission of HIV from mother to unborn child. Not all HIV positive mothers infect their children but about 30 per cent do during pregnancy, labour or delivery. Dr. Butler pointed out:
It is now possible to intervene during pregnancy to dramatically reduce this transmission rate. In 1994 a seminal study published by Connor et al (Connor E, et al, New England Journal of Medicine, 1994, 331, 1173) conclusively demonstrated the benefits of administering antiretroviral therapy, zidovudine, to pregnant women; the transmission rate remained at 25 per cent among those who received a placebo compared with 8 per cent in those receiving zidovudine. This has since been replicated in other studies. Even more optimistically, with the advent of more effective therapies, viral monitoring during pregnancy, and possibly for some deliveries by caesarean section, it is anticipated that this transmission rate can be further reduced to possibly 2 to 5 per cent.
That is an incredible reduction. These findings mean that for most children HIV is a preventable disease if HIV infection in their mothers is recognised early in pregnancy.
In Ireland we rely on women who feel they are at risk of having contracted HIV infection to identify themselves. We carry out unlinked testing on throwaway blood samples to ascertain the level of infection in pregnant women in general. From a combination of these results we know that many women do not realise they are infected. HIV infection is strongly linked to intravenous drug abuse but, in many cases, the drug use may not be by the woman but by her partner. Dr. Butler concluded that "relying on self disclosure by women of their risk status is an unreliable way to detect HIV infection in women".
For all screening programmes three conditions must be fulfilled: first, there must be a test that is scientific and specific, which we have; second, there should be an available intervention, which, as I said, now exists; and, third, there should be a significant prevalence of the disease, which, unfortunately, there is. Anonymous antenatal screening between 1992 and 1995 showed a prevalence in the Eastern Health Board area of one in 2,675 pregnant women and outside the Eastern Health Board area of one in 21,436 pregnant women. In the Rotunda Hospital, where I work and which has many inner city patients, in a paper published by Dr. Mary Cafferkey and her co-workers in 1997 there was a prevalence of one in 1,800. There are indications that while the incidence is not rising in the Eastern Health Board area it is increasing outside it; therefore, testing should not be in the Eastern Health Board area only.
Based on the prevalence of HIV infection in Ireland, ranging from one in 1,800 to one in 21,400 and tests costing £1.94 each, it would cost about £3,000 to £35,000 to detect each infected child. The cost of managing a child with AIDS for one year has been estimated at £36,000 sterling by a study carried out in St. Mary's Hospital, London.
On a cost basis alone, this clearly justified the immediate routine screening of pregnant women. However, what about the hidden costs? Can we deny unborn children the right to live without HIV infection? It is not just the suffering of these children and the grief of their death which matters, but the reality that with current therapies these children will grow to sexual maturity. The infected children of today will be the infected teenagers of tomorrow and sources of infection to others through sexual contact, as has happened in the United States of America. They will also be sources of vertical transmission to their children.
We already screen newborn babies for hypothyroidism which occurs in one in 3,500 births; phenylketoninea, which occurs in one in 4,500; galactosemia, which occurs in one in 19,000; homocysteinuria, which occurs in one in 63,000; and maple syrup urine disease, which occurs in one in 120,000. The likelihood of a child being born with HIV is much greater, yet we do not test for this. It is imperative that we now screen for HIV in pregnant women on a routine basis.
