Presence of heavy metals in the wastewater sludge has greatly hindered sludge land application. Bioleaching has been developed for heavy metal removal from sludge. The pH of the sludge is declined by microorganisms with S or FeS as energy source. Sludge considered to be used in land is mainly due to its fertilizer values as it contains nitrogen, phosphorus, and potassium. Therefore, it is important to understand how the bioleaching would impact on sludge characterization. In addition, pathogens are great threat to human health. The ability of pathogen elimination of bioleaching is highly concerned. In this review, the major heavy metals in the sludge are summarized. The change of nitrogen, phosphorus, and potassium after bioleaching is stated. The pathogen elimination due to bioleaching has been discussed. The work has provided an insight of research need in sludge bioleaching with the aim of residual sludge land application.