Background Extremely elevated intracranial pressure (ICP) in Patients with HIV and cryptococcal meningitis is a poor prognostic predictor of death during initial therapy.The risks associated with implanting a cerebrospinal fluid (CSF) shunt in immunocompromised patients with ongoing CSF infection have historically discouraged surgeons from implanting CSF shunts in patients with HIV and cryptococcal meningitis.It remains unclear if ventriculoperitoneal (VP) shunts can effectively provide long-term treatment for patients with intracranial hypertension and HIV-associated cryptococcal meningitis in China.Method The outcome of 9 patients with HIV-associated cryptococcal meningitis who were performed VP shunt for high ICP was retrospectively analyzed.The age, sex, clinical manifestations, neurological statuses, CSF features, image findings and other opportunistic infections were recorded for analysis.Result All patients had signs and symptoms of increased intracranial pressure, including headache, nausea and vomiting.7 patients (77.78％) had visual lose due to persistent papilledema.The median month from diagnosis of cryptococcal meningitis to VP shunt in these 9 patients was 5 months (range 0.5-12.5months).7 patients (77.78％) had good outcome with recover from 1month to 48months.2 patients had poor outcome.One died half a year after shunting operation due to severe side effect of antiretroviral drugs and the other one died two weeks after operation.Conclusion Patients with intracranial hypertension and HIV-associated cryptococcal meningitis who cannot tolerate cessation of external lumbar CSF drainage or frequent lumbar punctures may be considered for VP shunt placement despite severe immunosuppression and persistent CSF cryptococcal infection.