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

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 six months after starting 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:: 1236 deaths were recorded in 34680 patients followed for 174906 person-years. Relative mortality was lower in patients with higher CD4 count and lower HIV-1 RNA six months after starting ART, without prior AIDS, who were older, and who started ART after 2000. Compared to insured HIV negative lives, estimated relative mortality of patients aged 20-39 from France, Italy, UK, Spain and Switzerland, who started ART after 2000 had 6-month CD4 count ≥350 cells/mm and HIV-1 RNA <10 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 >50% of patients (those with lower relative mortality) could be insurable. CONCLUSIONS:: 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 >6 months.