My recent blood work at the end of November showed a viral load of 1280 and a cd4 still 700's. I hadn't missed any doses but became complacent because of my good numbers. Your opinion is appreciated. Resistance is what can happen when HIV grows in the presence of these meds. One way this happens, and perhaps the most common way, is that we have some degree of initial success, as you mention, but then it is just hard to remember to take meds every day each day.
People just forget.
It is the most common reason based on several surveys done. And unfortunately, HIV can regrow if it is just partially suppressed on meds - even after 11 hours past a scheduled dose. Now, just missing once after 11 hours may not be enough to lead to resistance. But over time, if the meds aren't there continuously, then HIV can start to regrow. And if it regrows while some but not enough of the meds are there, not enough to stop HIV from growing, this is what allows HIV to develop resistance to these meds.