Successfully treated HIV patients should be insured just like cancer survivors, Swiss research shows

The gap has closed between those living with HIV and other life-threatening illnesses, like cancer, as far as mortality is concerned, according to a new report from the Swiss HIV Cohort Study - as long as they are not coinfected with hepatitis C. The group suggests that people with HIV should be able to obtain life insurance in the same way as successfully treated cancer patients.

The Swiss HIV Cohort Study reports in the latest issue of the The Lancet that HIV-positive/hepatitis C-negative people on HAART who have a CD4 count over 250 cells/mm³ have done as well in the short-term as successfully treated cancer patients, regardless of viral load or CD4 nadir (lowest ever recorded CD4 count). The researchers argue that since the latter group are able to obtain life insurance, healthy people living with HIV should also be considered for life insurance under certain circumstances.

Looking at the period between January 1 1997 and December 31, 2001, the researchers compared data from 3963 members of the Swiss cohort with the official Swiss death registry in order to calculate the extra deaths per 1000 per year in people with HIV in comparison with the general population, and also with successfully-treated cancer patients (who have an excess death rate of 5-20 per 1000 patient years).

People with HIV in the study were assessed for treatment success - defined as attaining, at least once, a CD4 count of more than 250 cells/mm³ after January 1 1997 after more than six months on HAART.

In total 1645 (415.%) cohort members were found to be hepatitis C positive and 2318 hepatitis C negative. Compared with individuals who never attained a CD4 count above 250 cells/mm3, everyone who had a CD4 over 250 - and was not also coinfected with hepatitis C - had an excess death rate within the parameters of successfully treated cancer patients.

As expected, the lowest excess death rates (EDR) were seen in those who had both a CD4 count above 250 cells/mm³ and a viral load below 400, whether or not there had been a CD4 nadir below 250 cells prior to HAART (EDR = 3.1-3.4 per 1000 per year).

When hepatitis C coinfection was added to the equation the EDR ranged between 20.5 and 25.9, slightly above successfully treated cancer, but still well below the EDR for unsuccessful HAART (i.e. never achieving a CD4 of 250 cells/³), which ranged from 112.7-117.4.

There were too few hepatitis C antibody negative injection drug users (IDUs) and too few hepatitis C antibody positive non-IDUs to ascertain whether the excess death rates seen in the coinfected population were related more to lifestyle factors associated with IDU or to the effects of liver disease. Since 2001, however, new treatments for hepatitis C have become available that should positively affect this excess death rate.

The authors were unable to explain all the reasons for any excess deaths seen in the successfully treated HIV-positive/hepatitis C negative population, but note that a previous study found that heart attack risk amounts to about one death per 1000 patient-years of follow-up.

The authors conclude that “successfully treated HIV-positive and hepatitis C negative patients have a short term mortality as low as, or lower than that of, patients with cancer who have been successfully treated,” who are able to obtain life insurance, and argue that “this study provides preliminary actuarial evidence that life coverage could be considered under specific conditions.”