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(See the Editorial Commentary by Bennett, on pages 129–30.)

Background.  HIV-associated cryptococcal meningitis is associated with an estimated 600 000 deaths worldwide per year. Current standard initial therapy consists of amphotericin B (AmB) plus flucytosine (5-FC), but 5-FC remains largely unavailable in Asia and Africa. Alternative, more widely available, and/or more effective antifungal combination treatment regimens are urgently needed.

Methods.  Eighty HIV-seropositive, antiretroviral naive patients presenting with cryptococcal meningitis were randomized to 4 treatment arms of 2 weeks duration: group 1, AmB (0.7–1 mg/kg) and 5-FC (25 mg/kg 4 times daily); group 2, AmB (0.7–1 mg/kg) and fluconazole (800 mg daily); group 3, AmB (0.7–1 mg/kg) and fluconazole (600 mg twice daily); and group 4, AmB (0.7–1 mg/kg) and voriconazole (300 mg …