Are there situations when a person tests recent on the assay but was infected over a year ago?

Yes. The mean duration of recent infection is about 6 months, but there is a distribution around the mean, which can vary from ≤3 months to >9 months across individuals due to the variation in immune response. Based on this distribution, although we expect most persons who test RTRI- recent to have acquired HIV approximately within the last 12 months, there may be some who have had HIV for more than 12 months. Prior ART (particular for longer duration) or weak antibody development among elite controllers can increase the likelihood of testing false-RTRI-recent. The addition of viral load testing in a RITA can help identify and reclassify these persons. Additionally, clinical history can be used to identify and exclude from RTRI testing persons presenting to HTS with prior HIV diagnosis