Ok, just in case anyone wants to know, none of the AA cvars worked, but changing the postprocesing cvar worked.
Use the following to get rid of that terrible smearing:
sys_spec_postprocessing=2
I set everything else to 3, and the game is much nicer to look at now

In case anyone is interested, here's the full details config that I am using (skipping over FoV and keyboard cvars)
r_FSAA=0
r_UseEdgeAA=0
r_TexMaxAnisotropy=16
sys_spec_gameeffects=3
sys_spec_objectdetail=3
sys_spec_particles=3
sys_spec_physics=3
sys_spec_postprocessing=2
sys_spec_shading=3
sys_spec_shadows=3
sys_spec_sound=3
sys_spec_texture=3
sys_spec_water=3