After acute infection, most persons develop viral persistence. Fatigue, joint pain, depression and a variety of skin manifestations can occur but are uncommonly diagnostic. In otherwise-healthy persons infected at young ages, after decades some develop cirrhosis, end state liver disease or hepatocellular cancer (HCC). There are wide ranges of the frequencies of these outcomes due to difference in host factors such as race, age, HIV infection, and for progression to end stage disease, alcohol use (see text).