A membrane supported biofilm apparatus has a plurality of hollow fiber gas permeable membranes in a tank containing water to be treated. The membranes have an outside diameter of about 200 microns or less and occupy between 0.5% and 4% of the tank volume. A biofilm supported on the membranes occupies between about 40% and 80% of the volume of water to be treated in a reactor. The membranes may be oriented generally vertically and a spreader may be located near the bottom of the apparatus to disperse the membranes. Wastewater treatment processes are described. A process to dentrify water or treat oxidized contaminants comprises introducing hydrogen into an inner volume of the membranes to grow autotrophic organisms in the biofilm near the membrane and heterotrophic organism near the water. Another process is operated at a biomass concentration of at least 10 g/L and up to about 40 g/L to maintain a biofilm having a surface area of over 1000 square metres per cubic metre of tank volume. A hybrid process has suspended biomass and a membrane supported biofilm.