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

AIDS. 2013 Jun 19;27(10):1641-55. doi: 10.1097/QAD.0b013e3283601199.


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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Anti-HIV Agents / therapeutic use
  • Cohort Studies
  • Drug Therapy, Combination
  • Female
  • France / epidemiology
  • HIV Infections / drug therapy
  • HIV Infections / mortality*
  • Humans
  • Insurance, Health / statistics & numerical data
  • Italy / epidemiology
  • Life Tables
  • Male
  • Middle Aged
  • Risk Factors
  • Spain / epidemiology
  • Switzerland / epidemiology
  • United Kingdom / epidemiology
  • Young Adult


  • Anti-HIV Agents