I started taking Atripla six months ago. No resistance issues to any HIV meds prior to treatment and I have never missed a dose BUT although the viral load has fallen from 19,122 before treatment to 140 it is still not undetectable. (There was a rapid decline to 607 after the first month, but getting down from this to 140 has taken another five months.) My CD4 count has steadily risen from 361 (before treatment) to 532 (after three months). I'm reluctant to switch meds as I have no side effects and like the one-pill-a-day regime, but I am concerned that it's not working as well as it should. I usually Atripla at 11p.m. but there has been the odd occasion when I haven't taken it until around midnight. I was told it had a good half-life, though, so is that an issue? How much longer should I give it before switching? I'd really appreciate your thoughts.

Sometimes it can take longer than 6 months to get to undetectable. You have had an appropriate increase in CD4 count during that time frame. I don't think a couple of hours in dosing time would make any difference, as long as you have been adherent to the regimen every day. I would give this another couple of months and see whether you finally get over the goal line. If not, might be time for a change.