Facial emotional processing in HIV infection: relation to neurocognitive and neuropsychiatric status

Objective: To examine facial emotional processing in HIV+ individuals and its relation to neurocognitive performance, neuropsychiatric symptomatology and immune status. Method: Participants included 85 HIV+ individuals (83 males, 2 females) and 25 age-comparable HIV- individuals (22 males, 3 females). Participants underwent The University of Pennsylvania computerized neuropsychological facial emotion test battery, standardized neuropsychological testing, neurobehavioral questionnaires, a semistructured psychiatric interview, and an assessment of independence in activities of daily living. Results: Relative to HIV- controls, HIV+ individuals showed a mild difference for recognition of sadness (p = .02, d = 0.43), discrimination of happiness (p = .02, d = 0.52), and speed of recognition for fear (p = .04, d = 0.37). HIV+ individuals with HIV-associated neurocognitive disorder (HAND; 20%) had abnormal emotional facial recognition (p = .04; d = .59), and slower recognition of negative facial expressions (p < .01; d = .63-.83), as well as poorer discrimination of happy facial expressions (p < .003, d = .83). Apathy, depression, reduced independence in activities of daily living, and HIV biomarkers were not associated with reduced facial emotion recognition in the HIV+ group. Conclusions: Clinically stable HIV+ individuals show a mild level of emotional processing reduction that is dissociated from neuropsychiatric complaints. Individuals with HAND showed moderate to large emotional processing abnormalities, particularly for the timely recognition of negative expressions (fear, sadness, and anger). These findings warrant a more comprehensive and dynamic evaluation of emotional processing in HIV infection and an investigation of the integrity of the fronto-basal-amygdala circuits.