A comparison of clinical and cardiac biomarker profiles of patients with community-acquired pneumonia and with COVID-19 pneumonia in a high HIV prevalence adult population. Running title: Comparison of patients with CAP and COVID-19 pneumonia

Introduction There are no studies from sub-Saharan Africa comparing patients with community-acquired pneumonia (CAP) and those with COVID-19 pneumonia, which is what was undertaken in this study. Methods Consecutive adult patients hospitalized with CAP (n=59), or COVID-19 pneumonia (n=74) were compared with regard to co-morbidities, HIV status, routine laboratory parameters, and levels of systemic inflammatory and cardiac biomarkers. Results There were an equal number of males and females, but CAP patients were younger. Human immunodeficiency virus infection was more common in CAP patients, whereas other comorbidities were more prevalent in COVID-19 pneumonia. CAP patients had more cough, fever, greater tachycardia, and lower blood pressure, while dyspnoea, tachypnoea, and respiratory alkalosis were more prevalent in COVID-19. Several routine laboratory parameters differed. Cardiovascular biomarkers were mostly elevated in both groups compared to controls. However, levels of creatinine kinase-MB (CK-MB) and cardiac troponin I were significantly elevated in COVID-19 versus CAP patients. When compared by HIV status no difference in the cardiac biomarker levels was seen in CAP patients with and without HIV, but significantly higher levels were noted in the HIV-positive COVID-19 group. Conclusion Cardiac biomarker analysis suggests that HIV-infected patients with COVID-19 pneumonia may be at greatest risk of cardiovascular events.