HIV/AIDS pandemic has undergone a profound transformation from a once terminal diagnosis to its current status as a manageable chronic condition, comparable to diabetes. This shift is a testament to decades of scientific research and innovation, including the development of antiretroviral therapy (ART), long-acting injectable treatments, and preventive strategies that have significantly improved life expectancy and quality of life for people living with HIV (PLHIV). Despite this progress, challenges persist in achieving complete prevention, ensuring long-term treatment adherence, and securing equitable access to healthcare.
HIV remains a global public health challenge. At the end of 2024, an estimated 40.8 million people were living with HIV, and in that year approximately 630,000 people died from HIV-related causes.1 These figures underscore the ongoing burden of HIV and the importance of equitable access to care, an essential factor in public health and insurance frameworks.2 As science continues to reshape the future of HIV, our approach for assessing risk and insurability should evolve accordingly.
Therapeutic Innovation – Long-Acting ART and Its Implications
One of the most significant developments is the introduction of long-acting injectable antiretroviral therapy (LA‑ART). In 2021, the U.S. Food and Drug Administration (FDA) approved a combination of two injectable antiretrovirals, cabotegravir and rilpivirine, administered every four or eight weeks.3 This regimen has demonstrated over 90% sustained viral suppression in both clinical trials and real-world settings.4–7 Its safety profile is favourable, with mild injection site reactions being the most common side‑effect.8
Prevention Reimagined – Injectable PrEP and Population-Level Risk Reduction
Prevention remains a cornerstone of HIV control. While daily oral-pre-exposure prophylaxis (PrEP) has reduced HIV incidence, adherence remains a challenge. A breakthrough in this space is injectable lenacapivir. Approved by the FDA in June 2025 and endorsed by the World Health Organization in July 2025, lenacapavir is the first twice-yearly injectable PrEP option recommended for HIV prevention.9,10 This endorsement followed the results of two pivotal randomized controlled trials, PURPOSE 1 and PURPOSE 2, that reported lenacapivir’s efficacy in reducing HIV infection.11,12
In addition to prevention, lenacapivir is approved for treatment of multidrug-resistant HIV‑1 and achieves durable viral suppression with no cross-resistance to other drug classes.13,14 Its unique capsid inhibition mechanism and twice-yearly dosing schedule address key barriers to adherence and support broader access, especially in populations with limited healthcare infrastructure or challenges with daily medication routines.15,16
Underwriting Outlook – Translating Medical Progress into Risk Assessment
The evolving HIV landscape presents a clear opportunity for the insurance industry to further recalibrate how risk is assessed. With the approval of LA‑ART and the emergence of twice-yearly injectable PrEP, treatment adherence and viral suppression have become more stable and predictable. These advancements could have direct implications for underwriting via supporting more nuanced and evidence-based assessments of PLHIV, reflecting improved prognosis and reduced transmission risk.
While HIV remains a global health concern, the scientific progress made in recent years enables insurers to move beyond stigma, outdated assumptions and toward more individualized and data-driven evaluations. At Gen Re, we continue to update our underwriting guidelines to reflect these developments, ensuring our underwriting practices remain aligned with the realities of modern HIV care.
As innovation continues to reshape the future of HIV, we remain committed to translating medical progress into fair and data-driven risk assessment.
