Use of External Jugular Vein Puncture Technique in Ambulatory Settings for HCV or HIV/HCV Coinfected People Who Inject Drugs

Chronic hepatitis C virus infection is a global epidemic mainly affecting Eastern Mediterranean and European Regions with 2.3% and 1.5% prevalence, respectively. In addition, nearly 80% of people with HIV who inject drugs also have HCV infection. Current HCV direct acting antiviral agents (DAA) are well tolerated and available in most western countries. However, routine limb vein puncture remains a medical barrier for treatment of HIV/HCV coinfection of long-term people who inject drugs (PWIDs). In fact, difficult venous access due to poor vascular health consecutive to years of intravenous drug injection is a common constraint. External jugular vein puncture is a simple and safe procedure, which can easily be performed in an ambulatory setting in patients with very poor peripheral venous capital. This technique proves useful for blood screening and medical follow-up of polymorbid PWIDs (HIV/HCV co infection, non-infectious hepatic disorders, cardiovascular diseases, metabolic disorders, etc.) However no published protocol is currently available. This article reviews the indications of external jugular vein puncture, its' possible complications and the advantages it can offer long-term PWIDs followed elsewhere in view of overcoming medical obstacles for monitoring HIV therapy, DAAs and other concomitant treatments. It also provides a hands-on procedure of the technique based on the expertise of the Lausanne's addiction medicine clinic.