Background: Facial emotion recognition depends on cortical and subcortical networks. HIV infection of the central
nervous system can damage these networks, leading to impaired facial emotion recognition.
Methods: We performed a cross-sectional single cohort study consecutively enrolling HIV + subjects during routine
outpatient visits. Age, gender and education-matched HIV-negative healthy individuals were also selected. Subjects
were submitted to a Facial Emotion Recognition Test, which assesses the ability to recognize six basic emotions
(disgust, anger, fear, happiness, surprise, sadness). The score for each emotion and a global score (obtained by
summing scores for each emotion) were analyzed. General cognitive status of patients was also assessed.
Results: A total of 49 HIV + and 20 HIV−subjects were enrolled. On the Facial Emotion Recognition Test, ANOVA
revealed a significantly lower performance of HIV + subjects than healthy controls in recognizing fear. Moreover,
fear facial emotion recognition was directly correlated with Immediate Recall of Rey Words. The lower the patients’
neurocognitive performance the less accurate they were in recognizing happiness. AIDS-defining events were
negatively related to the correct recognition of happiness.
Conclusions: Fear recognition deficit in HIV + patients might be related to the impaired function of neural
networks in the frontostriatal system. AIDS events, including non-neurological ones, may have a negative effect on
this system. Inclusion of an emotion recognition test in the neuropsychological test battery could help clinicians
during the long term management of HIV-infected patients, to better understand the cognitive mechanisms
involved in the reduction of emotion recognition ability and the impact of this impairment on daily life