Protection Insurance and HIV

U=U image

U=U image HIV, or human immunodeficiency virus, is a retrovirus that if left untreated will invariably go on to cause AIDS, acquired immunodeficiency syndrome. It is generally other opportunistic infections, such as a form of pneumonia, that take advantage of the weakened immune system and lead to death. The first clinically observed cases of AIDS were in 1981 in America. Viruses seemingly causing AIDS were isolated in 1983 by two separate research teams. It wasn't until 1986 that the two differently named viruses were found to be the same and were renamed HIV.

HIV attacks macrophages and CD4 T cells, part of the immune system. HIV enters these cells and uses their cellular machinery to replicate its own RNA (a singular strand of genetic code) and proteins. These are then assembled into new HIV virions, thus increasing the levels of virus.

It wasn't until a decade later in 1996 that the first treatments against HIV became available. Today, a wide range of medications are used to treat HIV infection. They are all referred to as anti-retroviral therapies (ART). ART works by blocking or preventing one of the steps in the replication cycle of HIV. There are currently five different classes of ART depending on their mode of action.

Treatment typically comprises a combination of at least three ART drugs from different classes. This combination therapy approach helps to prevent drug resistance. ART is not a cure, its aim is to reduce the level of HIV in the blood. Modern assays which measure viral load can detect HIV down to a level of 20 copies per millilitre of blood. Anything lower than this is said to be an undetectable viral load.

It has now been accepted that HIV positive individuals with a consistently undetectable viral load cannot pass on the virus to sexual partners1. There is further good news for HIV positive people who start treatment and maintain an undetectable viral load. A recent study published in the Lancet showed that average life expectancy for those with treated HIV is comparable to those who are HIV negative2.

So how is all this affecting the ability of HIV positive individuals to obtain protection insurance such as life cover, critical illness cover and income protection?

In 1994, the Association of British Insurers (ABI) published the first Statement of Best Practice for Insurance and HIV. The first life insurance became available for HIV in 2009. There was unanimous agreement in 2015 that insurers should treat HIV like any other pre-existing medical condition. This led to the production, in 2016, of the ABI Guiding Principles for HIV and Life Insurance.

Despite this, the advances in treatment and life expectancy, life cover is still not widely available. For those insurers that do offer life cover, there are generally strict conditions and premium loadings (an amount payable in addition to the standard premium).

Although most insurers require applicants to be on treatment with an undetectable viral load, some are willing to consider those with a stable CD4 count who are not yet on treatment. One insurer has recently made significant changes to its underwriting of HIV, making premiums more affordable. They add a percentage loading based on the basic premium price. The percent is based on the applicant's individual circumstances and may be as low as 25%. For example, with a basic premium of £10 per month, a loading of 50% would add £5 per month giving a total payable of £15 per month.

There are currently no insurers offering critical illness cover or income protection to those with HIV4. A survey carried out by Unusual Risks found that 90% of HIV positive people would consider these products if they were available.

The National Aids Trust has recently published a report on HIV and financial products4. The report provides a number of recommendations for the public, insurers and regulators on how to improve access to financial products, including protection insurance, for those living with HIV. It also questions whether the level of loadings fairly represent the risk associated with HIV infection now.

If you are living with HIV and are considering life insurance then Maxwell Moore is happy to discuss your case in confidence.

If you have been diagnosed, or are living, with HIV and require support then you can contact the following charities.

3 Based on Vitality Life Underwriting Guide For Clients With HIV

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