Due to the introduction and improvements to combination antiretroviral therapy (ART) (therapeutics which can suppress the progression of the HIV virus) for HIV-positive people, the life-expectancy of patients has risen and HIV is becoming seen as a manageable chronic disease instead of a life sentence. However, access to life insurance for HIV-positive people remains limited.
A collaborative study published in AIDS by May and colleagues examined the possibility of insuring HIV-positive people in Europe. Given the long-term effectiveness of ART and the decline in mortality rates, they found that it would be feasible to insure many HIV-positive patients (to at least cover a mortgage) who have been treated with ART for more than 6 months.
The introduction of ART in 1996 has significantly altered the prognosis of patients diagnosed with HIV. Due to improvements in treatment regimens, such as one pill per day, and improved adherence to treatment, there has been a significant decline in mortality rates among HIV-positive people. However, despite recent evidence showing that a significant proportion of HIV-positive individuals in nine countries across Europe have a similar mortality rate to those who are living with other chronic diseases such as diabetes, they still have limited access to life insurance.
The study by May and colleagues evaluated the relative mortality rate of patients who had been receiving ART for 6 months compared to the insured general population in European countries participating in the ART Cohort Collaboration (ART-CC). The HIV-positive patients included in the study started the triple ART between 1996 and 2008, were not infected by injection drug use and had not tested positive for hepatitis C.
Among the 34 680 patients assessed, 1236 deaths were recorded over a period of 174 906 person-years.
HIV-positive patients were tested for their CD4 cell count as this is a clear indication of the health of their immune system. CD4 cells are white blood cells which play a pivotal role in the immune system. The HIV virus damages the immune system by targeting CD4 cells; therefore, a higher number of CD4 cells in a blood sample indicates a stronger immune system.
The results of the study showed that the relative mortality rate of patients who began ART after 2000 with improved CD4 cell counts after 6 months of ART declined when compared with insured HIV-negative individuals in the same population. This was observed in six European countries including the Netherlands, France, United Kingdom, Spain, Italy and Switzerland. The majority of the data came from the Netherlands and France, and 70% of the patients were men. It also showed that the mortality rate increased with age and for those diagnosed with AIDS prior to starting ART.
As with all studies, there are limitations and challenges. For this study in particular, the main challenge which remains is primarily the adherence to treatment for a prolonged period of time. Along with the quality of medical care available, challenges regarding the cost of therapeutics needed for long-term treatment, the presence of comorbidities (patients with additional chronic diseases such as tuberculosis) and drug interactions are also concerns. Also, as the study suggests poorer outcomes (higher mortality rate) for those with AIDS before starting ART, which would perhaps need to be considered on an individual basis by insurers.
Given the long-term effectiveness of ART, many HIV-positive people are living near-normal lives. The results of this study suggest that HIV could be managed as a chronic disease and therefore the lack of insurance products available to patients who have been successfully treated with ART for more than 6 months is no longer justified. Particularly given that many other groups such as cancer patients and diabetics with morbidities have a comparable mortality rate and are insured.
The data from the study provides evidence that life insurance could be extended to 20 years, which would mean life insurance for HIV-positive people could at least cover a mortgage. This study provides valuable information that could lead to improvements in quality of life for HIV-positive people.
Written By: Lacey Hizartzidis, PhD