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Annual deaths from cryptococcal meningitis are estimated to exceed half a million, most in HIV-infected people, with particularly high mortality in the developing world. Glucocorticoids have theoretical appeal as an adjunct to standard treatment for HIV-associated cryptococcal meningitis, but evidence is limited to animal and retrospective case studies.
In a randomized trial from southeast Asia and sub-Saharan Africa, patients with HIV-associated cryptococcal meningitis received either adjunctive dexamethasone or placebo. The trial was halted after enrollment of 451 patients. Dexamethasone recipients fared significantly worse than placebo recipients in mortality (47% vs. 41%) and disability at 10 weeks — and in adverse events at 6 months (66…