New hope for curing (and insuring) more individuals with HIV

Last month, speakers at the Conference on Retroviruses and Opportunistic Infections presented the first case of a woman who appears to be cured of HIV. She also is the first racially diverse individual to be cured of HIV through stem cell transplants, opening the door to people from different ethnic heritages to getting such treatment.

This is an important development, not merely on a medical front, but also from the perspective of increasing access to cutting-edge medicine for groups who previously did not have such options.

More soberingly, the news is also a sign of how far we still have to go in beating this virus nearly four decades after its discovery. Even though this new treatment inspires hope, its high-risk nature likely means it will only come into play for a fraction of the 37 million global HIV sufferers.

Four years ago, a HIV-positive woman suffering from acute myeloid leukemia, a potentially deadly blood cancer, underwent a transplant using donated blood stem cells that are resistant to HIV. She remains HIV-free today, despite having stopped antiretroviral drug treatment 14 months ago.

If this procedure sounds familiar, that's because two HIV-positive men (one white, one Latino) who also developed blood cancer have also experienced long-term remission (and cured) after previously undergoing similar procedures.

But there's a fundamental difference. While both men received their cells from adult donors whose stem cells were HIV-resistant, the woman treated at Weill Cornell Medicine in New York used two sources of stem cells: Those from a healthy adult relative, as well as umbilical cord blood from an unrelated newborn child whose cells contained the HIV-resistant gene. HIV-resistant stem cells are more commonly found in people of European heritage. Properly matching donors to recipients is important because they otherwise run a higher risk of their bodies rejecting them. This has been a hurdle for non-white patients. Umbilical cord blood is more widely available and does not need to be matched as closely to the recipient as bone marrow cells do. "The ability to use partially matched umbilical cord blood grafts greatly increases the likelihood of finding suitable donors for such patients," said Dr. Koen van Besien, one of the doctors who led the procedure.¹

Since bone-marrow transplants are risky, they are typically only carried out for people with high-risk cancer who otherwise could face death without such a procedure. Consequently, doctors believe only about 50 patients annually in the United States suffering from both blood cancer and HIV would likely benefit. This means that antiretroviral drugs that keep HIV in check remain the best option for the millions of people worldwide living with the disease.

Despite this reality, this latest advance still deserves to be cheered, not least because it has opened a new avenue of treatment to mixed race people who traditionally have been underserved by our healthcare systems. It's great to see people who previously were among the last to receive the most-advanced treatments suddenly have new options.

More generally, this new development marks another milestone in the quest to end the decades-old epidemic.² It shows that since the discovery of the HIV virus in around 1983 – and the initial, frustratingly slow progress to manage the disease –that dedicated experts are not content to stand still.

They continue to push the boundaries of what is possible.

These stories also invigorate insurers – and me personally. At Swiss Re, our goal is to make the world more resilient. We exist to close the protection gap and offer insurance to more people, especially those who were previously excluded. In fact, we helped pioneer the insurability of HIV patients. In 2003, we supported landmark research in The Lancet that paved the way for offering life cover to HIV positive individuals.

Since then, we've continued to push for more inclusive insurance, updating Life Guide to reflect the latest medical advances. Though this treatment is unlikely to become commonplace for the reasons explained above, we will continue to analyse and review the latest scientific evidence surrounding HIV, ensuring our clients have access to the most up-to-date and comprehensive evidence. 

In my 20 plus years in insurance, I've been lucky enough to witness, and even take part in, the huge strides made in improving insurance access. 20 years ago, the life expectancy of an individual with HIV looked very different – and so did their prospect of obtaining life & health insurance cover. Today, thanks to modern medicine, not only is HIV a manageable, chronic condition but it is also proving to be one that can be cured.

The noble mission of insurance is what drove me to the industry in the first place. Pushing the boundaries of what we thought was possible and working to make insurance fairer and more inclusive is why I'm staying.