Beyond accuracy: facial emotion perception bias in people with HIV in Uganda.

Cognitive complications remain common among people with HIV (PWH) globally, yet social cognition, critical for daily functioning, has received little attention, particularly in sub-Saharan Africa. We examined facial emotion perception (FEP), a core social cognitive process, among 235 PWH and 224 people without HIV (PWoH) from the Rakai Neurology Cohort Study. FEP was assessed using the FEP task and associations with cognitive and psychosocial factors were examined. While overall accuracy did not differ between groups, PWH demonstrated greater fear bias (Cohen’s d = 0.20, 95%CI 0.01,0.38) and lower sad bias (Cohen’s d=-0.21, 95%CI -0.40,-0.03) than PWoH. In PWH, better declarative memory was associated with higher accuracy for fear and neutral faces and with lower fear bias, whereas psychomotor speed was related to higher accuracy for sadness and higher sad bias. In PWoH, declarative memory related to anger recognition and reduced sad bias, whereas psychomotor speed was associated with improved accuracy for fear and neutral faces and lower anger bias. Psychosocial factors (e.g., anxiety, PTSD symptoms) were not related to FEP in either group. Findings indicate that HIV status is associated with differential patterns of FEP bias, with PWH showing heightened fear bias and PWoH demonstrating greater sad bias. These results highlight the potential value of FEP bias as a marker of brain health in HIV and underscore the importance of declarative memory and psychomotor speed as potential intervention targets to improve social functioning.