Social Cognition and HIV: Exploring the Profile of Cognitive Impairments in HIV-Associated Neurocognitive Disorders (HAND)

Abstract

The success of combined antiretroviral therapy has transformed Human immunodeficiency virus (HIV) infection from an acute and life-limiting condition to an enduring but treatable illness, marked by fluctuations in HIV-related health consequences and co-morbidities. HIV-associated neurocognitive disorders (HAND) are one such possible consequence and are of particular concern in light of their sustained high prevalence in people with otherwise well-managed HIV infection. Given the neuropsychological profile of HAND (affecting frontostriatal brain regions and associated executive functions), it has been suggested that HAND may have implications for social cognition; that is to say, the cognitive capacities that facilitate social interaction. Thus, the current study aimed to explore social cognitive performance in the neuropsychological profile of HAND. A diverse HIV-positive cohort (N=16), recruited across two outpatient services, were administered the Social Stories Questionnaire (Lawson, Baron-Cohen, & Wheelwright, 2004), Reading the Mind in the Eyes Test (Baron-Cohen, Wheelwright, Hill, Raste, & Plumb, 2001), and the Questionnaire of Cognitive & Affective Empathy (Reniers et al., 2011), alongside a standard neuropsychological battery. Using IMB SPSS v22, an exploratory group-level bivariate correlational analysis compared group scores against published normative data, and further Individual Profile Analyses explored cognitive differences within rather than across individuals to investigate trends not apparent at group-level. The sample demonstrated reliable performance weaknesses on both tests of social cognition (RMET and SSQ), independent of executive function and in the absence of global of specific impairments. Individual Profile Analyses revealed that these impairments were unrelated to stage of infection and occurred alongside (not before) cognitive decline in other core domains. Recommendations for further research are offered, drawing upon a critical review of the methodology employed. Clinical implications include; suggestions for increasing professional curiosity and empathy; psychoeducation; and the role of clinical neuropsychology in contributing to the development of the wider understanding of the potential emotional and behavioural sequelae of HAND.