Chronic liver disease in homeless individuals and performance of non‐invasive liver fibrosis and injury markers: VALID study. (10th December 2021)

• Record Type: Journal Article
• Authors: Hashim, Ahmed.; Bremner, Stephen; Grove, Jane I.; Astbury, Stuart; Mengozzi, Manuela; O'Sullivan, Margaret; Macken, Lucia; Worthley, Tim; Katarey, Dev; Aithal, Guruprasad P.; Verma, Sumita
• Is Part Of: Liver international. Volume 42:Number 3(2022)
• Page Start: 628
• Page End: 639
• Publication Date: 2021-12-10
• Subjects: community health services -- cytokines -- fibrosis -- hepatitis C -- homeless people; Liver -- Periodicals; Liver -- Diseases -- Periodicals; 616.362
• DOI: 10.1111/liv.15122
• Languages: English
• ISSNs: 1478-3223

Abstract

Abstract: Background/aims: Community‐based assessment and management of chronic liver disease (CLD) in people who are homeless (PWAH) remain poorly described. We aimed to determine prevalence/predictors of CLD in PWAH and assess the performance of non‐invasive liver fibrosis and injury markers. Methods: The V ulnerable A dult LI ver D isease (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) ≥8 kPa). 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 = .002) and HCV RNA positivity (OR 2.93, 95% CI 1.12‐7.66, P = .029). There was moderate agreement between LSM and Enhanced Liver Fibrosis (ELF) score (kappa 0.536, P < .001) for CSHF as assessed by LSM ≥8 kPa. Those with CSHF had significantly higher levels of IFN‐γ ( P = .002), IL‐6 ( P = .001), MMP‐2 ( P = .006), ccCK‐18 ( P < .001) and ELF biomarkers ( P < .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 liver 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.