By default ActiveState doesn't come with a C compiler, or build tools.

True, but (at least for 32-bit ActivePerl) ActiveState's repository does include PPM modules for dmake and MinGW. Once those are installed, ActivePerl is then able to install any module from CPAN (including XS based modules). Of course, the big catch is access to the matching ActiveState repository. For older versions of ActivePerl, that will require purchasing support from ActiveState. (I believe that there are extra steps and/or caveats to get 64-bit ActivePerl to have the appropriate/compatible compiler and tools in order to install modules directly from CPAN.)

Currently, my preference is to use Strawberry Perl. For any businesses that need/require a higher level of support and are able to afford it, ActiveState's ActivePerl may be a better solution for them.