From the initial recognition of HIV virus in 1981, HIV infection has turned from an almost universally fatal infection, to one that could be managed with medication to extend life, to a disease which can be controlled with newer and revolutionary medication therapies. While many companies continue to see the HIV virus as uninsurable, that corner has also been turned, and life insurance in selected cases of treated HIV infection is now possible. Even though the conditions that must be met are numerous and the criteria stringent, applicants with HIV now have the possibility of acceptable insurance offers.
We’ll concentrate here not on the history and diagnosis of HIV, but rather the circumstances that may result in a placeable offer for infected individuals. It’s important to note that people who are living with the HIV virus have longer and longer life expectancies with successful treatment and can approach or even achieve a normal life span with the available combination antiretroviral therapies. However, they are not “cured” of HIV but rather have the virus remain in a latent state. HIV virus is able to replicate itself into DNA and rest in an inactive state—the medication itself attacks the actively replicating virus. So medication “forever” is the rule, although recent advances may have monthly shots be given instead of daily regimens depending on the situation and response to the treatment by the body.
HIV is called a retroviral disease, which is the cause of AIDS (acquired immunodeficiency syndrome). HIV affects mainly immune system cells known as CD4+ T helper lymphocytes. When these cells decrease below a critical level (usually 200/mm3), cell mediated immunity is lost and the body is unable to fight even basic infections. Eventually CD4 cells are depleted, and the overwhelming infection causes body failure. CD4 counts are a consistent mortality risk factor. Others that lead to a poorer prognosis include high viral loads, IV drug use history, concurrent infection with hepatitis B or C, irregular use of medication, and any other condition that affects overall body health.
A number of conditions must be met for an applicant with HIV to qualify for life insurance coverage. There must be a minimum of six months to a year of treatment with highly active antiretroviral therapy. Viral load must be undetectable, indicating latent virus stage rather than active. CD4 counts have to be well above the minimum 200/mm3 mentioned previously, usually in excess of 500/mm3. There must be no concomitant infection with hepatitis B or C virus. There have to be complete and current medical records showing continuous follow-up and therapy. And, of course, there must be neither active substance abuse nor ratable medical condition in addition that would increase mortality assessment.
Another thing to consider is the course of the HIV virus and its effect on the body over time, regardless of current appropriate medical treatment. Even those on lifelong drug therapy suffer from higher rates of cardiovascular, kidney, liver, and neurologic disease. The disease takes a great toll even when successfully fought, and particularly those who did not receive the most recent effective classes of medication will have had their bodies decompensate over time, adding to mortality. Virtually any offer of life insurance in HIV infected individuals will be a rated one, even if all conditions for insurance are met and the applicant appears healthy.
Robert Goldstone, MD, FACE, FLMI
MD, FACE, FLMI, board certified internist and endocrinologist, was most recently vice president and chief medical officer for Pacific Life and Pacific Life and Annuity. He has extensive brokerage and life insurance experience, having been medical director at both MetLife Brokerage and Transamerica Occidental Life. Goldstone is board certified in insurance medicine and the inaugural recipient of the W. John Elder Award for Insurance Medicine Journalism Excellence. He was also honored as a fellow of the prestigious American College of Endocrinology and has written monthly for Broker World since 1991. Goldstone does consulting full or part-time as well as on a fill-in basis for companies who need a medical director/physician. He can be reached by telephone at 949-943-2310. Emaill: firstname.lastname@example.org.