ROCHESTER, Minn. — Before leading Mayo Clinic's fight against COVID-19, Andrew Badley spent decades battling another lethal virus: HIV.

Forty years after the first patient was diagnosed with the virus, it is still claiming lives, though the toll is much less devastating than it was in the early decades of its rampage.

There were 37.6 million people living with HIV in 2020, according to UNAIDS. According to the Centers for Disease Control and Prevention, 37,968 received an HIV-positive diagnosis in 2018, the last year for which data is available. There were 15,820 deaths that year.

Badley, who led Mayo Clinic's COVID-19 task force and continues to lead a lab focused on HIV research, reflects on how far the field has come and if a cure is in reach.

Q: What is the challenge of eradicating a virus like HIV and how does that differ from SARS-CoV-2?

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Influenza, or SARS-CoV-2, or Ebola — those viruses are characterized by if you get infected, you're sick, and then you either recover or you don't, and then the virus has gone away. The second kind of virus infection are viruses that persist. And examples of those viruses would be Hepatitis B, and Hepatitis C, and herpes simplex virus and HIV. And what's different about those viruses is that you get the first infection, sometimes you're not very sick at all with them. But after that acute phase, they persist, they enter into some of your cells, and they persist there for a lifetime.

When we're talking about HIV, it's a virus that persists. And when it persists inside of a cell, it can go to sleep: it's called a latent infection. So the cell looks no different than any other cell, but it has a virus inside of it. And every now and then that virus that's inside of it can wake up and activate, and spread virus all around the body again. The obstacle to curing HIV is to get rid of that cell population that harbors the integrated virus.

Q: Working with infectious diseases such as HIV often requires a higher security lab with special protocol and equipment. Talk about the experience of working in these spaces.

Federal regulatory agencies across the world have created different rules and regulations about what laboratory processes are required to reduce the risk of a lab worker acquiring these infections. For different viruses and different bacteria, there are different rules. For your average bacteria that might cause a urinary tract infection, for example, that's called a level two. Lab work for HIV and SARS-CoV-2 and others, that's called level three work. And then for things like Ebola, which is very infectious and very fatal, that's called level four work ... We do not have a level four lab at Mayo Clinic.

In our level three lab we have always had to gown and glove and mask to sterilize everything going into and out of the lab. That just becomes part of your daily process. And there are groups within Mayo and every other academic institution that routinely monitor the adherence to those precautions. We have to do regular updates and regular training to make sure we're using the latest and greatest techniques to make sure that we are preventing the possibility of spread of those viruses or bacteria.

Q: How much of your lab’s work is done in those high-security level three conditions?

We do infections of cells in a test tube with HIV almost every day, so people who work in my lab are in the level three lab almost every day. Now, they probably spend a couple hours in the level three lab and the rest of the time in the level two lab. But that varies day to day and week to week and project to project.

Q: Dr. Anthony Fauci has set a goal to eradicate HIV by 2030. What progress has the scientific community made toward achieving that goal?

HIV used to be, and I remember this era well, a diagnosis that was associated with near universal fatality over a period of years. Now it is a very, very manageable condition. The successes we achieved and the lessons we learned along the way have led to the majority of successes that we've seen in SARS-CoV-2. But because the technology is so advanced, what took us 10 or 20 years for HIV has taken us a year or a year-and-a-half for SARS-CoV-2.

Q: How do you process the losses that have been sustained through these 40 years of fighting HIV — 34.7 million deaths — and still remain hopeful for the future?

My thoughts are punctuated by specific memories and specific events. One of my earliest memories of HIV was when I was still a college student, and I was doing some research in an infectious disease lab. I remember hearing the story of an HIV infected person, and it was one of the first persons at that particular hospital. And nobody in those days really knew what caused AIDS. People were afraid, and the patient was ostracized. It was just a horrible, horrible circumstance, and it made me want to understand more.

Today, if you're diagnosed with HIV (emphasis on if you're diagnosed) and if you have access to care, and if you can get the right drugs, and if you take the right drugs — and there's four things there — then your life expectancy is near normal, which is a truly profound change from where it was 30 years ago when I first saw my first patient.

But what is difficult is the inequity. And speaking globally, there's different ability to be diagnosed for HIV, there's different ability to access care, there's different ability to have access to medicines. And there's different abilities to take those medicines, often because of insurance issues and things.

Yeah, so there's a lot of work to be done in terms of improving equity across the globe, so that everybody who is infected, can learn that they're infected, and therefore treat themselves and not spread it to others, to get access to people who are specialists in HIV care.

There's a lot of room to go. But it's really remarkable how much success we've had in 30 years (of my career).

Q: What's been the most rewarding part of working in this field?

I'm very fortunate to work in an area that I love, and I think it is very, very important. I was involved in some of the studies that led to the creation of the HIV protease inhibitor drugs that all of a sudden started to save lives. And that was incredibly rewarding. I love what I do in the lab. And I believe that what we're doing in the lab is important, and will have a long-lasting impact on our ability to cure HIV. And of course, over the past two years, I've been very fortunate to have had a leadership role in the COVID fight ... I will always be proud of the work that our teams have done. So I'm very fortunate to have had what I consider to be a very rewarding career.

EDITOR'S NOTE: Responses have been edited for brevity and clarity.