---
title: "COVID-19 Mortality Risk in People with HIV in Florida Before and After COVID-19 Vaccine Availabili"
id: "pubmed-42758717"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42758717"
content_type: "clinical_feed_article"
specialty: "Critical Care"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42758717/"
doi: "10.1371/journal.pone.0358543"
published_at: "2026-09-18T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# COVID-19 Mortality Risk in People with HIV in Florida Before and After COVID-19 Vaccine Availabili
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42758717
- **Specialty:** [Critical Care](https://medichelpline.com/clinical-feed/critical-care.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42758717/)
- **DOI:** [10.1371/journal.pone.0358543](https://doi.org/10.1371%2Fjournal.pone.0358543)
- **Published At:** 2026-09-18T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- Objective: The study evaluated associations between **COVID-19** vaccine availability and differences in COVID-19 mortality risk across subgroups among 122,527 **people with HIV (PWH)** in Florida. - Data sources: Florida HIV surveillance data were linked with the **Social Vulnerability Index (SVI)** and Rural-Urban Commuting Area Codes; analyses used a competing risks model. - Time periods: "Before vaccine availability" was defined as 3/1/2020–4/30/2021 and "during vaccine availability" as 5/1/2021–12/31/2021. - Overall mortality: COVID-19 mortality rates increased from 22.3 to 27.5 per 100,000 person-months from the pre-vaccine to the vaccine availability period; the rise was partly attributed to the Delta variant surge in mid-to-late 2021. - Race/ethnicity: Adjusted hazards for COVID-19 mortality remained elevated for **Non-Hispanic Black (NHB)** PWH compared with Non-Hispanic White (NHW) PWH both before (HR 2.06, 95% CI 1.45–2.91) and during (HR 1.60, 95% CI 1.13–2.27) vaccine availability. - Hispanic PWH: Relative hazard vs. NHW was elevated before vaccine availability (HR 2.24, 95% CI 1.55–3.23) and attenuated during vaccine availability (HR 1.03, 95% CI 0.68–1.57). - Social vulnerability: Living in ZIP code–level areas with high overall SVI was associated with elevated COVID-19 mortality hazard during the vaccine availability period (HR 1.75, 95% CI 1.04–2.97) in the final model. - Interpretation: Although aggregate mortality increased during vaccine availability, subgroup patterns varied; persistent inequities were observed, particularly for PWH in more socially vulnerable areas. - Causal inference: The authors note these observational comparisons do not estimate the causal effect of vaccination uptake. - Public health implication: The study supports the need for tailored vaccination strategies and structural interventions to advance equity in pandemic response among PWH.
## Clinical Analysis & Structured Key Points
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Lauderdale Research & Education Center, School of Forest, Fisheries and Geomatics Sciences, Geospatial Analytics, Technology, and Open Research \(GATOR\) Lab, University of Florida, Davie, Florida, United States of America."), [Giselle A Barreto](https://pubmed.ncbi.nlm.nih.gov/?term=Barreto+GA&cauthor_id=42758717)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42758717/#full-view-affiliation-1 "Robert Stempel School of Public Health and Social Work, Department of Epidemiology, Florida International University, Miami, Florida, United States of America."), [Shelbie Burchfield](https://pubmed.ncbi.nlm.nih.gov/?term=Burchfield+S&cauthor_id=42758717)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42758717/#full-view-affiliation-2 "Robert Stempel School of Public Health and Social Work, Department of Biostatistics, Florida International University, Miami, Florida, United States of America."), [Diana M Sheehan](https://pubmed.ncbi.nlm.nih.gov/?term=Sheehan+DM&cauthor_id=42758717)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42758717/#full-view-affiliation-1 "Robert Stempel School of Public Health and Social Work, Department of Epidemiology, Florida International University, Miami, Florida, United States of America.") Affiliations Expand ### Affiliations * 1 Robert Stempel School of Public Health and Social Work, Department of Epidemiology, Florida International University, Miami, Florida, United States of America. * 2 Robert Stempel School of Public Health and Social Work, Department of Biostatistics, Florida International University, Miami, Florida, United States of America. * 3 Ft. Lauderdale Research & Education Center, School of Forest, Fisheries and Geomatics Sciences, Geospatial Analytics, Technology, and Open Research (GATOR) Lab, University of Florida, Davie, Florida, United States of America. * PMID: **42758717** * DOI: [ 10.1371/journal.pone.0358543 ](https://doi.org/10.1371/journal.pone.0358543) Item in Clipboard # COVID-19 mortality risk among people with HIV in Florida before and after the introduction of COVID-19 vaccines: A population-based study Tendai N R Gwanzura et al. PLoS One. 2026. Show details Display options Display options Format Abstract PubMed PMID PLoS One Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22PLoS+One%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22PLoS+One%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42758717/) . 2026 Sep 18;21(9):e0358543. doi: 10.1371/journal.pone.0358543. eCollection 2026. ### Authors [Tendai N R Gwanzura](https://pubmed.ncbi.nlm.nih.gov/?term=Gwanzura+TNR&cauthor_id=42758717)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42758717/#short-view-affiliation-1 "Robert Stempel School of Public Health and Social Work, Department of Epidemiology, Florida International University, Miami, Florida, United States of America."), [Mary Jo Trepka](https://pubmed.ncbi.nlm.nih.gov/?term=Trepka+MJ&cauthor_id=42758717)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42758717/#short-view-affiliation-1 "Robert Stempel School of Public Health and Social Work, Department of Epidemiology, Florida International University, Miami, Florida, United States of America."), [Tan Li](https://pubmed.ncbi.nlm.nih.gov/?term=Li+T&cauthor_id=42758717)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42758717/#short-view-affiliation-2 "Robert Stempel School of Public Health and Social Work, Department of Biostatistics, Florida International University, Miami, Florida, United States of America."), [Levente Juhasz](https://pubmed.ncbi.nlm.nih.gov/?term=Juhasz+L&cauthor_id=42758717)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42758717/#short-view-affiliation-3 "Ft. Lauderdale Research & Education Center, School of Forest, Fisheries and Geomatics Sciences, Geospatial Analytics, Technology, and Open Research \(GATOR\) Lab, University of Florida, Davie, Florida, United States of America."), [Giselle A Barreto](https://pubmed.ncbi.nlm.nih.gov/?term=Barreto+GA&cauthor_id=42758717)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42758717/#short-view-affiliation-1 "Robert Stempel School of Public Health and Social Work, Department of Epidemiology, Florida International University, Miami, Florida, United States of America."), [Shelbie Burchfield](https://pubmed.ncbi.nlm.nih.gov/?term=Burchfield+S&cauthor_id=42758717)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42758717/#short-view-affiliation-2 "Robert Stempel School of Public Health and Social Work, Department of Biostatistics, Florida International University, Miami, Florida, United States of America."), [Diana M Sheehan](https://pubmed.ncbi.nlm.nih.gov/?term=Sheehan+DM&cauthor_id=42758717)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42758717/#short-view-affiliation-1 "Robert Stempel School of Public Health and Social Work, Department of Epidemiology, Florida International University, Miami, Florida, United States of America.") ### Affiliations * 1 Robert Stempel School of Public Health and Social Work, Department of Epidemiology, Florida International University, Miami, Florida, United States of America. * 2 Robert Stempel School of Public Health and Social Work, Department of Biostatistics, Florida International University, Miami, Florida, United States of America. * 3 Ft. Lauderdale Research & Education Center, School of Forest, Fisheries and Geomatics Sciences, Geospatial Analytics, Technology, and Open Research (GATOR) Lab, University of Florida, Davie, Florida, United States of America. * PMID: **42758717** * DOI: [ 10.1371/journal.pone.0358543 ](https://doi.org/10.1371/journal.pone.0358543) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Objective:** Assess associations between COVID-19 vaccine availability and differences in COVID-19 mortality risk across subgroups among 122,527 people with HIV (PWH) in Florida. **Methods:** Analyzed HIV surveillance data, Social Vulnerability Index (SVI), and Rural-Urban Commuting Area Codes using a competing risks model to compare COVID-19 mortality among PWH before (3/1/2020-4/30/2021) and during (5/1/2021-12/31/2021) vaccine availability. **Results:** Overall COVID-19 mortality rates increased from before to during the vaccine availability period (22.3 vs. 27.5 per 100,000 person-months), driven in part by the Delta variant surge in mid-to-late 2021. Compared to Non-Hispanic White (NHW) PWH, adjusted COVID-19 mortality hazards remained elevated for Non-Hispanic Black (NHB) PWH both before (HR 2.06, 95% CI 1.45-2.91) and during (HR 1.60, 95% CI 1.13-2.27) vaccine availability. For Hispanic PWH, the relative hazard compared to NHW was elevated before (HR 2.24, 95% CI 1.55-3.23) and attenuated during vaccine availability (HR 1.03, 95% CI 0.68-1.57). In the final model, living in ZIP Code-level areas of high social vulnerability (overall SVI high vs. low) was associated with elevated hazard during vaccine availability (HR 1.75, 95% CI 1.04-2.97). **Conclusions:** Overall COVID-19 mortality rates were higher during the vaccine availability period (27.5 vs. 22.3 per 100,000 person-months); however, subgroup patterns varied substantially. Inequities persisted in key subgroups and were most pronounced among PWH living in more socially vulnerable areas. These observational comparisons do not estimate the causal effect of vaccination uptake. **Public health implications:** Tailored vaccination strategies and structural interventions remain essential to advancing equity in pandemic response among PWH. Copyright: © 2026 Gwanzura et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. 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