I have been taking Viramune and Truvada for almost 5 years. I have always taken my pills exactly 12 hours apart. My cell phone reminds me most of the time. I have only had 1 small spike in my VL when I had a chest cold. Twice in the last 5 years I have missed my evening dose of Viramune. Is this safe? I panic when I can't take my pill exactly at the 12 hour mark. My VL is still undetectable.

Good news for you. You do not have to torture yourself so much when you are late taking this combination of medications. Both Truvada (the coformulation of Viread and Emtriva), as well as Viramune have very long half lives, which means that these drugs stay in your system for a long time after you have taken the dose. This attribute make possible for these drugs to be taken a bit late without significant risk. In fact, a seldom dose missed of either Viramune or Truvada, after you have been taking them for such a long time, and responding with an undetectable viral load, will probably have very little risk, if any. We still recommend you to take the meds as instructed and not to miss them.