OBJECTIVES Maraviroc (MVC) is the first CCR5 antagonist licensed for antiretroviral therapy of patients with CCR5-tropic HIV-1. The objective of this study was to predict the long-term clinical impact and cost-effectiveness of MVC in treatment-experienced adults with HIV/AIDS in Mexico. METHODS The AntiRetroviral Analysis by Monte Carlo Individual Simulation (ARAMIS) model was adapted to the Mexican context to predict clinical and economic outcomes of treating with optimized background therapy (OBT) versus testing for viral tropism status and treating with OBT ± MVC accordingly in treatment-experienced adults in Mexico. Baseline characteristics and efficacy were from the MOTIVATE trials' screening cohort. Costs and population mortality data were specific to Mexico collected from the Social Security Mexican Institute (IMSS). Results were reported from the perspective of healthcare payers using a 5% rate for discounting. Utility values for the quality adjustment of survival were obtained from published literature. Deterministic sensitivity analyses were conducted by means of repeat microsimulations. RESULTS Compared to treatment with OBT alone, treatment with OBT ± MVC contingent on tropism test result increased projected undiscounted life expectancy and discounted quality-adjusted life expectancy from 7.54 to 8.71 years and 4.42 to 4.92 quality-adjusted life years (QALYs), respectively, at an incremental cost of $21,329 USD. The resultant incremental cost-effectiveness ratio (ICER) was $42,429 USD per QALY gained. The ICER was considerably lower when MVC was modeled as a protease inhibitor replacement in individuals with HIV susceptible to ≤2 components of OBT ($29,737 USD); the ICER was higher in individuals susceptible to ≥3 OBT components ($67,171 USD). CONCLUSIONS In treatment-experienced individuals with HIV/AIDS in Mexico, a strategy of OBT ± MVC contingent on tropism test result may be cost-effective compared to OBT alone, particularly in individuals with limited options for active ART.