Estimating the Prevalence of Advanced Fibrosis in Homeless Adults with Hepatitis C in Boston

Background and aims. Hepatitis C virus (HCV) infection is highly prevalent among homeless individuals, but the scope of HCV-associated liver fibrosis in this population is poorly understood. Methods. Using the FIB-4 Index, we describe the prevalence and correlates of advanced fibrosis among a retrospective cohort of all homeless-experienced adults with HCV seen at Boston Health Care for the Homeless Program (BHCHP) over a one-year period. Results. Of 832 BHCHP patients with HCV, 15.8% had advanced fibrosis. In multivariable regression analysis, alcohol use disorder (adjusted odds ratio [aOR] 2.50, 95% confidence interval [CI] 1.65–3.81) and having unknown or poorly characterized housing circumstances (aOR 2.88, 95% CI 1.02–8.14, relative to housed patients) were independently associated with advanced fibrosis. Conclusions. The prevalence of advanced fibrosis in this cohort of homeless adults with HCV appears similar to national estimates among housed individuals, but their psychosocial complexity is greater, especially among those who are older.