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Chronic Liver Disease in Homeless Individuals and Performance of Non-Invasive Liver Fibrosis and Injury Markers: VALID Study

Hashim, A; Bremner, S; Grove, JI; Astbury, S; Mengozzi, M; O’Sullivan, M; Macken, L; Worthley, T; Katarey, D; Aithal, GP; Verma, S


A Hashim

S Bremner

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Assistant Professor

M Mengozzi

M O’Sullivan

L Macken

T Worthley

D Katarey

S Verma


Background/aims: Community-based assessment and management of chronic liver disease (CLD) in people who are homeless (PWAH) remains poorly described. We aimed to determine prevalence/predictors of chronic liver disease (CLD) in PWAH and assess performance of non-invasive hepatocyte fibrosis and injury markers.
Methods: The Vulnerable Adult LIver Disease (VALID) study provided a “one-stop” liver service based at homeless hostels. Our primary outcome was the prevalence of clinically significant hepatic fibrosis (CSHF) (liver stiffness measurement (LSM) > 8kPa).
Results: Total individuals recruited were 127, mean+SD age 47+9.4 years, 50% (95% CI 41%-59%) and 39% (95% CI 31%- 48%) having alcohol dependence and a positive HCV RNA respectively. CSHF was detected in 26% (95% CI 17%-35%), independent predictors being total alcohol unit/week (OR 1.01, 95% CI 1.00-1.02, p=0.002) and HCV RNA positivity (OR 2.93, 95% CI 1.12-7.66, p=0.029). There was moderate agreement between LSM and Enhanced Liver Fibrosis (ELF) score (kappa 0.536, p<0.001) for CSHF as assessed by LSM >8kPa. Those with CSHF had significantly higher levels of IFN-γ (p=0.002), IL-6 (p=0.001), MMP-2 (p=0.006), ccCK-18 (p<0.001) and ELF biomarkers (p<0.001), compared to those without CSHF. Service uptake was >95%. Direct acting antiviral (DAA) treatment completion was 93% (95% CI 77%-99%), sustained virological response (SVR) being 83% (95% CI 64%-94%). Conclusion: There is a significant liver disease burden from HCV and alcohol in PWAH. Non-invasive hepatocyte fibrosis and injury markers can help in identifying such individuals in the community. Despite a challenging cohort, excellent service uptake and high DAA-based SVRs can be achieved.


Hashim, A., Bremner, S., Grove, J., Astbury, S., Mengozzi, M., O’Sullivan, M., …Verma, S. (2021). Chronic Liver Disease in Homeless Individuals and Performance of Non-Invasive Liver Fibrosis and Injury Markers: VALID Study. Liver International,

Journal Article Type Article
Acceptance Date Nov 25, 2021
Online Publication Date Nov 30, 2021
Publication Date Nov 30, 2021
Deposit Date Nov 26, 2021
Publicly Available Date Dec 1, 2022
Journal Liver International
Print ISSN 1478-3223
Electronic ISSN 1478-3231
Publisher Wiley
Peer Reviewed Peer Reviewed
Keywords homeless people, community health services, fibrosis, hepatitis C, cytokines
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