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The paper presents a comprehensive review of the current status of integrated high temperature proton exchange membrane fuel cell (HT-PEMFC) and methanol steam reformer (MSR) systems. It highlights the advantages and limitations of the technology and outlines key areas for future improvement. A thorough discussion of novel reformer designs and optimizations aimed at improving the performance of the reformer, as well as different integrated MSR-HT-PEMFC system configurations are provided. The control strategies of the system operation and system diagnosis are also addressed, offering a complete picture of the integrated system design. The review revealed that several processes and components of the system should be improved to facilitate large-scale implementation of the MSR-HT-PEMFC systems. The lengthy system startup is one area that requires improvements. A structural design that is more compact without sacrificing performance is also required, which could possibly be achieved by recovering water from the fuel cell to fulfill MSR's water needs and consequently shrink the fuel tank. Reformer design should account for both heat transfer optimizations and reduced pressure drop to enhance the system's performance. Finally, research must concentrate on membrane materials for HT-PEMFC that can operate in the 200–300 °C temperature range and catalyst materials for more efficient MSR process at lower temperature should be investigated to improve the heat integration and overall system efficiency.