Bio-oxidation has proved to be a viable process for the oxidative pretreatment of refractory gold-bearing sulfides. Generally, the oxidation rate is maximal at 20% solids for high sulfide content materials [ca. 30% sulfur]. Low grade ores [1% sulfur] have been successfully oxidized at 55% solids, indicating a link between the sulfide grade of the material and the optimal solids concentration for operation. Concentrations of high solids have been reported to lower oxidation rates, increase lag times, and decrease the ultimate extent of oxidation. This review discusses the various factors that have been proposed as causes of these phenomena. The factors include oxygen and carbon dioxide availability, low bacteria-solids ratio; mechanical damage or inhibition of the bacteria, inhibition of bacterial attachment, and the buildup of toxic leach products or other detrimental substances such as some flotation reagents.