Cardiovascular disease (CVD) is the leading cause of morbidity and mortality globally, posing a particularly significant threat to people with HIV (PWH). To address this, CVD prevention plans rely on prediction models like atherosclerotic cardiovascular disease (ASCVD) risk scores to estimate the risk of heart disease. However, previous studies have called into question whether these commonly used prediction models perform well among people with HIV, and there remains a gap in understanding of what these scores mean for PWH in low- and middle-income countries (LMICs).