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We aimed to determine prevalence\/predictors of CLD in PWAH and assess the performance of non\u2010invasive liver fibrosis and injury markers.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The <jats:bold>V<\/jats:bold>ulnerable <jats:bold>A<\/jats:bold>dult <jats:bold>LI<\/jats:bold>ver <jats:bold>D<\/jats:bold>isease (VALID) study provided a \u201cone\u2010stop\u201d liver service based at homeless hostels. Our primary outcome was the prevalence of clinically significant hepatic fibrosis (CSHF; liver stiffness measurement (LSM) \u22658\u00a0kPa).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Total individuals recruited were 127, mean\u00a0\u00b1\u00a0SD age 47\u00a0\u00b1\u00a09.4\u00a0years, 50% (95% CI 41%\u201059%) and 39% (95% CI 31%\u201048%) having alcohol dependence and a positive HCV RNA respectively. CSHF was detected in 26% (95% CI 17%\u201035%), independent predictors being total alcohol unit\/week (OR 1.01, 95% CI 1.00\u20101.02, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.002) and HCV RNA positivity (OR 2.93, 95% CI 1.12\u20107.66, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.029). There was moderate agreement between LSM and Enhanced Liver Fibrosis (ELF) score (kappa 0.536, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.001) for CSHF as assessed by LSM \u22658\u00a0kPa. Those with CSHF had significantly higher levels of IFN\u2010\u03b3 (<jats:italic>P<\/jats:italic>\u00a0=\u00a0.002), IL\u20106 (<jats:italic>P<\/jats:italic>\u00a0=\u00a0.001), MMP\u20102 (<jats:italic>P<\/jats:italic>\u00a0=\u00a0.006), ccCK\u201018 (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.001) and ELF biomarkers (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.001), compared to those without CSHF. Service uptake was \u226595%. Direct acting antiviral (DAA) treatment completion was 93% (95% CI 77%\u201099%), sustained virological response (SVR) being 83% (95% CI 64%\u201094%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>There is a significant liver disease burden from HCV and alcohol in PWAH. Non\u2010invasive liver fibrosis and injury markers can help in identifying such individuals in the community. Despite a challenging cohort, excellent service uptake and high DAA\u2010based SVRs can be achieved.<\/jats:p><\/jats:sec>","DOI":"10.1111\/liv.15122","type":"journal-article","created":{"date-parts":[[2021,11,30]],"date-time":"2021-11-30T23:11:14Z","timestamp":1638313874000},"page":"628-639","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Chronic liver disease in homeless individuals and performance of non\u2010invasive liver fibrosis and injury markers: VALID study"],"prefix":"10.1111","volume":"42","author":[{"given":"Ahmed.","family":"Hashim","sequence":"first","affiliation":[{"name":"Department of Clinical and Experimental Medicine Brighton and Sussex Medical School Brighton UK"},{"name":"Department of Gastroenterology and Hepatology University Hospitals Sussex NHS Foundation Trust Brighton 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