Eh, anti-aliasing isn't a thing that is game-specific. Video cards today come equipped with the means to do it themselves, albeit with a performance hit.
That said, no, I don't use anti-aliasing, and it's not necessarily needed. However, some people tend to swear by it because they hate jaggies. I can stand them in most cases, and I'd rather take performance over image quality (though I generally keep graphics settings at highest because my computer can handle just about anything out right now, as well as in the future). When you're getting low framerates (sub-40 fps for newer games, sub-60 fps for older ones), then image quality is probably the thing that won't be on your mind.
When it comes down to realism, then of course it's important. Your goal is to make the player think that the player is doing what they are doing in real life, not actually playing a game that attempts to mimic real life.