In addition to the direct effect adverse drug reactions (ADRs) have on increased morbidity and mortality, their indirect impact on antiretroviral adherence and subsequent drug resistance is a major problem for HIV health services in a resource-limited setting. ADR is a major factor contributing to the interruption of antiretroviral intake in patients with good adherence to highly active antiretroviral therapy (ART). Antiretroviral non-adherence results in viral drug resistance, which derails antiretroviral effectiveness and causes higher costs for complicated treatment regimens; a burden that is more significant in resource-limited countries. Moreover, the costlier second-line treatment regimens (2-9 times higher in price than first-line regimens) are unaffordable for individual or government agencies in developing countries. This situation forms the basis for development of a pharmacogenomics initiative in Thailand, with special focus on HIV. The first target is to improve the prescription algorithm by personalizing the initial drug regimen; increasing the regimens efficacy; and simultaneously avoiding ADR. The ultimate aim of this initiative is to minimize the cost of ART for the public health system by incorporating research findings. Integrating HIV-1 pharmacogenetic screening tests into Thailandâs universal health-care system is a major challenge for the future and, if successfully implemented, they will eventually benefit both individuals and society.