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When a character gains 4 levels of exhaustion their max HP are halved.

In the section on the 'Death Curse' in The Tomb of Annihilation:

A humanoid whose hit point maximum is reduced can't increase or restore it. This is true whether the creature's hit point maximum is reduced by the Soulmonger or by some other life-draining effect, such as the touch of a wight, wraith, or similar creature.

Does this mean that a character who reaches level 4 exhaustion can never gain back their full hp?

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Exaustion is not covered by the effect.

The key portions of the effect of the curse are:

the creature's hit point maximum is reduced by the Soulmonger

and

other life-draining effect, such as (...)

EDIT:

(from comments)

This [not defining what life-drain is] might be an undersight from the developers. They are creating an umbrella definition for "life draining" (reminiscent of the old AD&D "energy drain" or 3.5 "negative levels" mechanics) without explaining it fully. But from the list of examples, we can know what it means: those necrotic damage types that cannot be healed until a certain condition is met, usually caused from undead attacks.

In the line of ruling from the sage advice, the effects do what they say, not what they don't say.

I'm applying two 5e premises:

  • "specific beats general" and

  • "does that is written, and only that".

First they go into the general "HP reduction". Then they specify what kinds of HP reduction are included in the effect. Most of the rules discussions about 5e are caused by people wanting to take one piece of writing beyond what is written. There is no "hidden subtext".

[Making a Jeremy Crawford voice impersonation]: "If the curse included the HP reduction of exaustion, it would say so"

So only in the two cases above, will the curse prevent the HP from coming back.

The HP reduction from exaustion will be lifted when the exaustion level that caused it is removed.

Also, the HP max reduction is not permanent. When (and if) the curse is lifted, people can heal. More info in the primer pdf. It is mostly for AL play, but the curse's rulings work for table play too.

Another possible way out maybe is to go die in another plane of existance, as this sage advice hints at.

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    \$\begingroup\$ In the "only what they say" vein, why doesn't "a humanoid whose hit point maximum is reduced can't increase or restore it" apply to exhaustion? I.e. what makes you read {soulmonger, life-draining} as the exhaustive list of what is covered by the curse rather that as examples of two (likely) thinks that could do it? Also, what are you seeing in the primer that helps? To be clear: I'm not disagreeing: I've got no idea where I stand on this one yet, and it hasn't come up at either of my ToA tables. But I reviewed the same things you did and don't see a clear answer so wonder I'm missing. \$\endgroup\$ – nitsua60 Oct 3 '17 at 11:02
  • \$\begingroup\$ @nitsua60 two 5e premises: "specific beats general" and "does that is written, and only that". First they go into the general "HP reduction". Then they specify what kinds of HP reduction are included in the effect. Most of the rules discussions about 5e are caused by people wanting to take one piece of writing beyond what is written. There is no "hidden subtext". [Makes a Jeremy Crawford voice impersonation]: "If the curse included the HP reduction of exaustion, it would say so" \$\endgroup\$ – Mindwin Oct 3 '17 at 12:19
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    \$\begingroup\$ So, only an effect that is called 'Life Drain'? This seems odd, since life drain is not defined in the rules anywhere, but is merely the name of an ability that some creatures have. What about a vampires 'Bite' attack? \$\endgroup\$ – Destruktor Oct 3 '17 at 14:55
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    \$\begingroup\$ @destruktor This might be an undersight from the developers. They are creating an umbrella definition for "life draining" (reminiscent of the old AD&D "energy drain" or 3.5 "negative levels") without explaining it fully. But from the list of examples, we can know what it means: those necrotic damage types that cannot be healed until <condition> is met, usually from undead. I don't have the vampire entry here, but if it deals necrotic damage that cannot be healed, it falls in this category. \$\endgroup\$ – Mindwin Oct 3 '17 at 15:17
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    \$\begingroup\$ @Mindwin I am inclined to believe that it is an oversight, as the reference to 'life-draining effects' seems like it is intended to refer to abilities belonging to creatures that deal necrotic damage. This would exclude attacks like the Clay Golem's slam attack or Otyugh's bite or Blue Slaad's claw (which causes disease but does not deal necrotic damage). \$\endgroup\$ – Destruktor Oct 3 '17 at 19:27

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