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

Kaulich-Bartz, J; Dam, W; May, MT; Lederberger, B; Widmer, U; Phillips, AN; Grabar, S; ... Writing committee for the Antiretroviral Cohort Collaboration, ; + view all (2013) Insurability of HIV positive people treated with antiretroviral therapy in Europe: collaborative analysis of HIV cohort studies. AIDS , 27 (10) pp. 1641-1655. 10.1097/QAD.0b013e3283601199. Green open access

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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 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.

Type: Article
Title: Insurability of HIV positive people treated with antiretroviral therapy in Europe: collaborative analysis of HIV cohort studies
Open access status: An open access version is available from UCL Discovery
DOI: 10.1097/QAD.0b013e3283601199
Publisher version: http://dx.doi.org/10.1097/QAD.0b013e3283601199
Language: English
Additional information: This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivitives 3.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. http://creativecommons.org/licenses/by-nc-nd/3.0. PMCID: PMC3678894
Keywords: Antiretroviral therapy, Cohort study, HIV, Insurability, Life Tables
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health > Infection and Population Health
URI: https://discovery.ucl.ac.uk/id/eprint/1396851
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