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Introduction: Because of improved life expectancy in people living with HIV (PLWH), liver disease is increasingly being recognized. We assessed nonviral chronic liver disease burden in PLWH., Methods: The HIV non-virAL liver disease study (2014-2021) prospectively recruited PLWH with elevated serum alanine aminotransferase levels and negative hepatitis serology. Clinically significant hepatic fibrosis (CSHF) was defined as liver stiffness measurement of >7.1 kPa and hazardous alcohol use as Alcohol Use Disorders Identification Test score ≥ 8. Primary outcome was prevalence/predictors of CSHF., Results: Total recruited were n = 274, 92% male, median age 52 (45-59) years, and 96% having undetectable HIV viral load. Overall, n = 97 (35%) had hazardous alcohol use, n = 72 (26%) had metabolic syndrome, and 17%-27% had exposure to hepatotoxic antiretrovirals. Prevalence of CSHF was 20% (n = 54), prevalence of cirrhosis (liver stiffness measurement > 12.5 kPa) being 7% (19/274). Risk factors for CSHF were hazardous alcohol use in 44% (n = 24), metabolic syndrome in 46% (n = 25), and hepatotoxic antiretrovirals in 56% (n = 30), most having more than one risk factor. Independent predictors of CSHF were serum high-density lipoprotein (odds ratio [OR] 0.220; 95% confidence interval [CI]: 0.061 to 0.790, P = 0.020) (inverse relationship); serum aspartate aminotransferase (OR 1.033, 95% CI: 1.001 to 1.067, P = 0.045), and didanosine use (OR 2.878, 95% CI: 1.228 to 6.774, P = 0.015). Moderate-severe hepatic steatosis was identified in 52% (n = 142). FIB-4 and aspartate aminotransferase-to-platelet ratio index performed poorly in predicting CSHF (positive predictive value 27.3% and 30.6%, respectively) and advanced fibrosis (≥F3) (positive predictive value 17.6% and 5.9%, respectively)., Conclusion: In this study, 20% of PLWH had CSHF associated with high prevalence of hazardous alcohol use/metabolic syndrome/potentially hepatotoxic antiretrovirals. These potentially modifiable risk factors need addressing., Competing Interests: S.V. none pertaining to this manuscript. In general, research grants, consultancy and speaker fees Gilead Sciences; Speaker Fees Abbvie; supply of consumables Rocket Medical/Becton Dickinson; Y.G. none pertaining to this manuscript. In general research grants, consultancy and speaker fees Gilead Sciences, ViiV and Dr Falk. The remaining authors have no funding or conflicts of interest to disclose., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

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 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) ≥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. [ABSTRACT FROM AUTHOR]