Can genomics provide a new level of strategic intelligence about rapidly evolving pathogens? We have developed a new approach to measure the rates of all possible evolutionary pathways in a genome, using conditional Ka/Ks to estimate their “evolutionary velocity”, and have applied this to several datasets, including clinical sequencing of 50,000 HIV-1 samples. Conditional Ka/Ks predicts the preferred order and relative rates of competing evolutionary pathways. We recently tested this approach using independent data generously provided by Shafer and coworkers (Stanford HIV Database), in which multiple samples collected at different times from each patient make it possible to track which mutations occurred first during this time-course. Out of 35 such mutation pairs in protease and RT, conditional Ka/Ks correctly predicted the experimentally observed order in 28 cases (p=0.00025). Conditional Ka/Ks data reveal specific accessory mutations that greatly accelerate the evolution of multi-drug resistance. Our analysis was highly reproducible in four independent datasets, and can decipher a pathogen’s evolutionary pathways to multi-drug resistance even while such mutants are still rare. Analysis of samples from untreated patients shows that these rapid evolutionary pathways are specifically associated with drug treatment, and vanish in its absence.