title: Insurability of HIV-positive people treated with antiretroviral therapy in Europe: collaborative analysis of HIV cohort studies.
abstract: OBJECTIVE
  To increase equitable access to life insurance for HIV-positive individuals by identifying subgroups with lower relative mortality.
  
  
  METHODS
  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.
  
  
  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 more than 6 months.
authors: Swiss Re Limited, Zurich, Switzerland.
authors: Josee
authors: J
authors: Kaulich-Bartz
authors: Wayne
authors: W
authors: Dam
authors: Margaret T
authors: MT
authors: May
authors: Bruno
authors: B
authors: Lederberger
authors: Urs
authors: U
authors: Widmer
authors: Andrew N
authors: AN
authors: Phillips
authors: Sophie
authors: S
authors: Grabar
authors: Amanda
authors: A
authors: Mocroft
authors: Josep
authors: J
authors: Vilaro
authors: Ard
authors: A
authors: van Sighem
authors: Santiago
authors: S
authors: Moreno
authors: François
authors: F
authors: Dabis
authors: Antonella D'Arminio
authors: AD
authors: Monforte
authors: Ramon
authors: R
authors: Teira
authors: Suzanne M
authors: SM
authors: Ingle
authors: Jonathan A C
authors: JA
authors: Sterne
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D015331:Cohort Studies; D004359:Drug Therapy, Combination; D005260:Female; D005602:France / Q000453:epidemiology; D015658:HIV Infections / Q000188:drug therapy / Q000401:mortality*; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D007558:Italy / Q000453:epidemiology; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D013557:Switzerland / Q000453:epidemiology; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents