Well there is the managed C++ backend, if you're into that sort of thing. I've been known to use it once or twice. :-)

I did use it a few times, back when .NET was still beta. So I went through Managed C++ and C++/CLI transition.

I also find it nice that with C++/CX VC++ is offering what C++ Builder does for years in terms of C++ RAD development.

Nowadays most of the consulting projects I work on are in JVM and .NET land.

What I really wanted to say it that I would like to see NGEN and .NET JIT offer the same type of optimizations as VC++ does, like SIMD, auto-vectorization and such.

When targeting Windows Phone 8, .NET gets compiled to native code with such type of optimizations using a cloud based AOT compiler. Maybe those improvements will eventually be brought into the standard framework.