Insurability of HIV-positive people treated with antiretroviral therapy in Europe: collaborative analysis of HIV cohort studies

Josee Kaulich-Bartz, Wayne Dam, Margaret T May, Bruno Lederberger, Urs Widmer, Andrew N Phillips, Sophie Grabar, Amanda Mocroft, Josep Vilaro, Ard van Sighem, Santiago Moreno, François Dabis, Antonella D'Arminio Monforte, Ramon Teira, Suzanne M Ingle, Jonathan A C Sterne, Writing Committee for the Antiretroviral Therapy Cohort Collaboration, Josee Kaulich-Bartz, Wayne Dam, Margaret T May, Bruno Lederberger, Urs Widmer, Andrew N Phillips, Sophie Grabar, Amanda Mocroft, Josep Vilaro, Ard van Sighem, Santiago Moreno, François Dabis, Antonella D'Arminio Monforte, Ramon Teira, Suzanne M Ingle, Jonathan A C Sterne, Writing Committee for the Antiretroviral Therapy Cohort Collaboration

Abstract

Objective: To increase equitable access to life insurance for HIV-positive individuals by identifying subgroups with lower relative mortality.

Design: Collaborative analysis of cohort studies.

Methods: We estimated relative mortality from 6 months after starting antiretroviral therapy (ART), compared with the insured population in each country, among adult patients from European cohorts participating in the ART Cohort Collaboration (ART-CC) who were not infected via injection drug use, had not tested positive for hepatitis C, and started triple ART between 1996-2008. We used Poisson models for mortality, with the expected number of deaths according to age, sex and country specified as offset.

Results: There were 1236 deaths recorded among 34,680 patients followed for 174,906 person-years. Relative mortality was lower in patients with higher CD4 cell count and lower HIV-1 RNA 6 months after starting ART, without prior AIDS, who were older, and who started ART after 2000. Compared with insured HIV-negative lives, estimated relative mortality of patients aged 20-39 from France, Italy, United Kingdom, Spain and Switzerland, who started ART after 2000 had 6-month CD4 cell count at least 350 cells/μl and HIV-1 RNA less than 10⁴ copies/ml and without prior AIDS was 459%. The proportion of exposure time with relative mortality below 300, 400, 500 and 600% was 28, 43, 61 and 64%, respectively, suggesting that more than 50% of patients (those with lower relative mortality) could be insurable.

Conclusion: The continuing long-term effectiveness of ART implies that life insurance with sufficiently long duration to cover a mortgage is feasible for many HIV-positive people successfully treated with ART for more than 6 months.

© 2013 Creative Common License

Figures

Fig. 1
Fig. 1
Mortality rates according to age and country of insurance population (upper panels) and weighted European mortality comparing insurance population and general population (lower panels).
Fig. 2
Fig. 2
Percentage relative mortality compared with HIV-negative insured lives (actual/expected claims ratio) of HIV-positive people according to CD4 cell count 6 months after start of ART, duration of ART, age group and calendar period of initiation of ART, among individuals without an AIDS diagnosis and with 6-month HIV-1 RNA less than 1000 copies/ml and in countries other than the Netherlands.

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Source: PubMed

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