CYP2B6*6 genotyping appears to be a promising approach towards the prediction of efavirenz toxicity and risk of developing resistant mutations to nevirapine. The use of cost-effective technologies to screen for the allele may therefore become part of routine clinical practice, for which benefits in terms of cost reduction for governments and patients are evident. However, pharmacogenomics has not yet lived up to its hype and benefits in both the developed and developing worlds in particular sub-Saharan Africa where access to basic healthcare services is limited. Although numerous reports have advocated for the implementation of CYP2B6*6-guided drug therapy in HIV patients receiving efavirenz or nevirapine, this has not been effected yet. The reasons require both practical and clinical considerations.