Ohio and Indiana are part of a cluster of Midwestern states where AIDS cases appear to be rising this year, even though the rate of new cases has been declining nationwide.

        Whether the disparity reflects a data reporting quirk or a shift in AIDS trends remains unclear.

        The statistics come from a weekly reportby the federal Centers for Disease Control and Prevention that tracks 22 infectious diseases from AIDS to malaria to rubella.

        The report shows that every state in the east north central region (Ohio, Indiana, Illinois, Michigan and Wisconsin) reported an increase in AIDS cases through Nov. 11 this year compared to the same period last year.

        Regionwide, there was a 26 percent increase in cases reported. In Ohio, the figurerose 16 percent from 421 cases to 489. In Indiana, there was a 15 percent increase from 282 cases to 324.

        Kentucky, which is part of the east south central region, was down nearly 30 percent from 241 cases to 169.

        Nationally, AIDS reports are down 11 percent. And while some other states reported increases, every other region except the east north central reported an overall decrease in AIDS cases.

        The concentration of rising case reports in the Midwest raised eyebrows at the Ohio Department of Health and at AIDS Volunteers of Cincinnati, but experts at those organizations say they do not know what, if anything, is causing the change.

        The Ohio figures could be a quirk caused by the way the state reports AIDS data, said Elizabeth Cross, chief of AIDS/HIV surveillance at the Ohio Department of Health.

        “In Ohio, we've gone two years with vacancies in our department. This year, we went from one to four case workers. We're identifying cases this year that should have been reported in earlier years,” she said.

        Nationwide, there have been concerns that cocktails of multiple anti-AIDS drugs are starting to lose their effect. There also have been questions about whether low-income and rural people with HIV are getting the medications promptly.

        These factors could mean more HIV-positive patients are developing full-blown AIDS. However, Ms. Cross said she has not heard medical experts in Ohio reporting a surge of such patients.

        At AVOC, counselors and case workers also have worried that young people have become less afraid of AIDS, in part because they have not seen friends die from the disease as often as people did a decade ago, said Kathryn Thompson, education coordinator.

        But an increase in risky behavior — such as sharing needles among drug users or having unprotected sex — would result in more HIV-positive patients, not necessarily more people with full-blown AIDS, she said.

        To have full-blown AIDS, the virus has to cause immune cell counts to drop to dangerous levels — which generally takes several years after being infected.

        In fact, reports of HIV incidence, or new infections, have been down in Ohio this year, Ms. Cross said.

        At the CDC, officials say the increase in Midwestern AIDS reports is more likely to be a data reporting fluke than an actual public health concern.

        Through the year, the CDC reports AIDS statistics as states turn them in. Even after the year ends, many states take a few months to submit final reports.

        “It might be that counties in (Ohio and other states with rising AIDS cases) are working faster this year,” said Kitty Bina, a CDC spokeswoman. “Those figures can change a lot.”

        If the cocktail drug treatments were really starting to fail for large numbers of patients, such a trend would be more likely to show up in California or New York before Ohio and other Midwest states because they have more people with HIV infections, Ms. Bina said.

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