First, I'm going to disagree. The could be an incestuous relationship between adults, even in separate households. There could be legitimate consent.
I actually see no great harm in adult incest. If it's not directly harming anyone, I don't much care. I assumed this question was about family incest, which was probably perfunctory.
But when it comes to adult/child incest, or child/child incest, or any incest with disproportionate levels of consent, it's rape of the worst kind.
My big one is birth defects and genetic abnormalities.
I'm getting déjà vu. Wasn't it established in an old topic that it isn't a concern unless it's multi-generational incest? And that only relates to procreation, not all incestuous sexual relationships. That seems like one of the most trivial arguments against it.
Edit: That may have been among cousins, actually. Siblings probably have a much higher rate. But, again, I doubt many siblings are interested in procreation. Or sex, for that matter. Yuck. Glad I'm an only child.