Hashim A, Bremner S, Grove JI, et al. - People who are homeless (PWAH) face a significant liver disease burden due to HCV and alcohol. Identification of such people in the community can be aided by non-invasive hepatocyte fibrosis and injury markers. Service uptake was excellent and direct acting antiviral (DAA)-based sustained virological responses (SVRs) were high despite a challenging cohort.

• In this study (VALID study), 127 homeless people with mean±SD age 47±9.4 years were included to ascertain prevalence/predictors of chronic liver disease in PWAH as well as to evaluate performance of non-invasive hepatocyte fibrosis and injury markers.

• Presence of clinically significant hepatic fibrosis (CSHF) was evident in 26%, and total alcohol unit/week (OR 1.01) and HCV RNA positivity (OR 2.93) were the independent predictors.

• A moderate agreement was found between liver stiffness measurement (LSM) and Enhanced Liver Fibrosis (ELF) score (kappa 0.536, p<0.001) for CSHF as evaluated by LSM ≥8kPa.

• Significantly higher levels of IFN-γ, IL-6, MMP-2, ccCK-18 and ELF biomarkers were detected in participants with CSHF vs those without CSHF.

• Service uptake was ≥95%, and DAA treatment completion was 93%; SVR was 83%.